New data examines sustained glycemic control with exenatide once weekly vs. insulin glargine

Post-hoc analysis found that, despite continued titration with insulin glargine, more diabetes patients achieved sustained glycemic control with exenatide once-weekly, according to data presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria.

Three-year data from the DURATION-3 trial, sponsored by AstraZeneca, were studied to explore the association between baseline characteristics or early (≤12 week) treatment responses with sustained glycaemic control, comparing exenatide once-weekly with titrated insulin glargine (glargine). Patients received exenatide once-weekly (n=233) or glargine (n=223) as add-on therapy to metformin alone or in combination with a sulphonylurea. Inability to achieve sustained glycaemic response was defined as HbA_1c > 7% at 2 consecutive visits or HbA_1c > 9% at 1 visit after 26 weeks of treatment.

In particular, the results showed the following:

· In the intent-to-treat patient population, 50% of the exenatide once weekly group achieved sustained glycemic control compared to 43% in the glargine group. Of those who completed 3 years, 43% and 33% respectively, achieved sustained glycemic control.

· Regardless of therapy, for every 1% elevation in baseline HbA_1c (> 7%) the risk of losing glycaemic control increased by 90% (P=.0002).

· For every 10% higher baseline HOMA-B, the risk of losing glycaemic control decreased by 11% (P=.0288).

· The rate of weight change in weeks 1 through 8 was the most relevant early treatment response predictor of HbA_1c control (P =.0640).

Baseline HbA_1c and HOMA-B significantly impacted the odds of patients achieving sustained control.

Additionally, the results suggest the rate of weight change following treatment initiation [weeks 1 through 8] may potentially predict the probability of patients achieving longer-term sustained glycemic control in adult patients with type 2 diabetes, according to the study.