New research published this week in Diabetes Care shows that Byetta® (exenatide) added to basal insulin glargine and metformin can achieve similar glycaemic control, with the additional benefit of reduction in weight, compared to treatment with bolus insulin lispro added to basal insulin glargine and metformin in adult patients with type 2 diabetes.
In the first ever study to directly compare a glucagon-like peptide-1 (GLP-1) receptor agonist added to basal insulin to a standard basal-bolus insulin regimen, exenatide achieved its primary endpoint of non-inferioriority to bolus insulin lispro in reducing HbA1c levels at 30 weeks (-1.13% and -1.10%, respectively; p-value = 0.627). These Phase III results are particularly significant as exenatide is the first and only short-acting GLP-1 receptor agonist demonstrated to be as effective as mealtime insulin lispro in improving glycaemic control.
“The results of this study demonstrate that, on a background of basal insulin, exenatide twice-daily is as effective as bolus insulin in improving blood glucose levels. The additional benefit of weight loss is also important, especially in comparison to the weight gain that we usually see in patients taking insulin,” noted Grace Vanterpool, Diabetes Nurse Consultant, Featherstone Clinic, Southall, Middlesex. “In my clinical experience, patients are more likely to adhere to a therapy that does not increase, but actually lowers their weight, as this is very important to them. Weight loss can also have a positive effect on their overall quality of life."
Patients treated with exenatide also showed improvements across a range of factors compared to insulin lispro, such as significant reductions in mean body weight (-2.5 kg compared to 2.1 kg) and systolic blood pressure (SBP) (-4.1 mmHg compared to 0.4 mmHg), as well as a lower incidence of minor hypoglycaemia (30% compared to 41%). Additionally, the study explored overall treatment satisfaction and changes in quality of life (QoL) as a result of the impact the treatments had on patients’ weight. After 30 weeks of treatment, patients in the exenatide group reported greater treatment satisfaction (mean change of 2.19 points versus 1.4 points) and improved quality of life (mean change of 4.4 points versus 0.51 points) compared to the bolus insulin lispro group.