Once weekly exenatide is an alternative treatment to daily basal insulin

Typically, basal insulin is chosen as the add-on treatment in patients with severe hyperglycemia. However, it has been questioned whether it is the best option, according to research presented in June at the American Diabetes Association 73rd Scientific Sessions, in Chicago

A recent study conducted in San Diego compared the efficacy and tolerability of exenatide once weekly with those of daily basal insulin in patients with Type 2 diabetes mellitus who had a baseline A_1C of 8.5% or higher and who were taking metformin with or without SFU.

Data were pooled from two 26-week, randomized, controlled studies: 137 patients were taking weekly exenatide, and 126 patients were taking daily basal insulin. According to the study results, patients treated with weekly exenatide had a significantly greater decrease in A_1C  from baseline than those treated with basal insulin and were significantly more likely to reach an A_1C  goal of less than 7.0% (39.4% in the exenatide group compared with 23.0% in the basal insulin group).

There was less decrease in fasting plasma glucose in the weekly exenatide group than in the daily basal insulin group. Additionally, mean weight loss with weekly exenatide was -2.4 ± 0.23 kg, whereas weight gain with basal insulin was 2.0 ± 0.24 kg. Patients in the weekly exenatide group were significantly more likely to achieve a composite goal (A_1C <7.0%, no weight gain, and no hypoglycemia [requiring assistance or self-treated with blood glucose <54 mg/dL]) than were patients in the basal insulin group (33.6% compared with 3.2%).

Hypoglycemia occurred at a rate of 0.08 exposure-adjusted events per patient year in the exenatide group and 0.37 events in the basal insulin group. In the basal insulin group, the most common adverse events were hypoglycemia (38.9%) and nasopharyngitis (19.0%), and in the exenatide group, the most common adverse events were nausea (28.5%), nasopharyngitis (16.8%), and hypoglycemia (14.6%).

Study results found that weekly treatment with exenatide was associated with significantly greater reductions in A_1C  and body weight and a lower rate of hypoglycemia than treatment with basal insulin. Additionally, results seem to suggest that weekly exenatide treatment is a good treatment alternative to basal insulin in those patients with A_1C ≥8.5% who are receiving treatment with oral antihyperglycemic medications and are concerned about weight gain and the risk of hypoglycemia.