Combination therapy with insulin glargine and exenatide: real-world outcomes in patients with type 2 diabetes

Author： Levin Philip Wei Wenhui Wang Li Pan Chunshen Douglas Damon Baser Onur

ISSN： 1473-4877

Source： Current Medical Research and Opinion, Vol.28, Iss.3, 2012-03, pp. : 439-446

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Abstract

Abstract Objective:To investigate the real-world use of combination insulin glargine/exenatide therapy for type 2 diabetes mellitus (T2DM) and associated treatment persistence and glycemic control. Methods:In this retrospective study, data were extracted from a national US insurance claims database for patients with T2DM for whom insulin glargine and exenatide were co-prescribed in differing order: insulin glargine added after exenatide (EXE++); exenatide added after insulin glargine (GLA++); glargine and exenatide initiated together (GLA ++ EXE). Patients had continuous health plan coverage for 6 months pre- (baseline) and 1-year post-index (follow-up). Results:A total of 453 patients were eligible for analysis: 141 patients were included in the EXE++ cohort, 281 in the GLA++ cohort, and 31 in the GLA ++ EXE cohort. There were significant differences between the groups at baseline, including a significantly lower A1C in the GLA++ versus the EXE++ cohort (p == 0.0023). Around one third of patients stayed on both drugs up until the end of the follow-up period (GLA++: 30.2%%; EXE++: 29.0%%; GLA ++ EXE: 29.0%%). However, more patients stayed on insulin glargine than on exenatide in each cohort. Significant A1C reductions were observed in each of the cohorts at follow-up: GLA++: −0.4%%; EXE++: −0.9%%; GLA ++ EXE: −1.2%%; p < 0.01, and were significantly higher in the GLA ++ EXE and EXE++ cohorts than in the GLA++ cohort (p == 0.03 and p == 0.002, respectively). The mean number of hypoglycemic events increased slightly from baseline but remained low in each of the cohorts (GLA++: 0.12 to 1.42; EXE++: 0.09 to 1.04; GLA ++ EXE: 0.23 to 1.87 per patient, all p > 0.1). Conclusions:Combined therapy with insulin glargine and exenatide resulted in A1C reductions in T2DM patients with poor glycemic control without a significantly increased risk of hypoglycemia irrespective of treatment order. Limitations of this study are the between-cohort differences at baseline, lack of a comparator group, and small n number, particularly in the GLA ++ EXE cohort.