ADA: Exenatide Bests Insulin As Second-Line Therapy

Weekly injections in diabetes patients tied to improved blood sugar control, greater weight loss

MONDAY, June 28 (HealthDay News) -- In patients with type 2 diabetes who have inadequate glycemic control despite treatment with maximum tolerated doses of first-line blood-glucose lowering drugs for three months or longer, a once-weekly injection of exenatide may be associated with better glycemic control and greater weight loss than daily injections of insulin glargine, according to a study published in the June 26 American Diabetes Association meeting Special Issue of The Lancet.

Michaela Diamant, M.D., of the VU University Medical Centre in Amsterdam, Netherlands, and colleagues from the DURATION-3 study randomly assigned 456 patients to add either exenatide (2 mg, once-a-week injection) or insulin glargine (once-daily injection, starting dose 10 IU, target glucose range 4.0 to 5.5 mmol/L) to their blood glucose-lowering regimens. After 26 weeks, the researchers found that exenatide was associated with a modestly greater decrease in the mean level of HbA1c than insulin glargine (1.5 versus 1.3 percent). They also found that the exenatide group had a lower rate of hypoglycemia as well as a mean loss of 2.6 kg in bodyweight, while the insulin-glargine group had a mean gain of 1.4 kg in bodyweight. However, the rate of discontinuation because of adverse events was higher in the exenatide group (5 versus 1 percent).

According to the findings of a related study (DURATION-2) published online June 26 in The Lancet to coincide with presentation at the American Diabetes Association's 70th Scientific Sessions, held from June 25 to 29 in Orlando, Fla, type 2 diabetes patients treated with metformin are more likely to achieve optimum glucose control, weight loss, and a minimum occurrence of hypoglycemic episodes if once-weekly exenatide is added to their treatment regimen instead of maximum daily doses of pioglitazone or sitagliptin.

"Currently, there is more promise, few disadvantages, and some unknowns about treatment with long-acting exenatide for diabetes," write the authors of a comment accompanying the first study. "Despite advances in antihyperglycemic therapy, a drug which would lead to substantial prevention of macrovascular and microvascular complications, decreases mortality, and is convenient and affordable, remains the undiscovered Holy Grail of diabetes management."

Both studies were funded by Amylin Pharmaceuticals and Eli Lilly and Company; several authors disclosed financial relationships with these and other pharmaceutical and medical device companies.

Abstract - DURATION-3
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Abstract - DURATION-2
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Rick Ansorge

Rick Ansorge

Published on June 28, 2010

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