Exenatide vs. Sitagliptin on 24H Glucose

In an 8-week, double-blind, randomized, crossover, single-center study, eighty-six subjects (58% female, body mass index 35 ± 5 kg/m², hemoglobin A1c 8.3 ± 1.0%) received either exenatide 10 μg (subcutaneous) twice daily or sitagliptin 100 mg (oral) daily for 4 weeks and crossed to the other therapy for an additional 4 weeks. The main outcome was time-averaged glucose during the 24-h inpatient visits.

From the results it showed that both treatments decreased average 24-h glucose, but exenatide had a greater effect [between-group difference: -0.67 mmol/l, 95% confidence interval (CI): -0.9 to -0.4 mmol/l]. Also, both treatments decreased 2-h postprandial glucose (PPG), area under the curve of glucose above 7.8 mmol/l (140 mg/dl) and 11 mmol/l (200 mg/dl) and increased the time spent with glucose between 3.9 and 7.8 mmol/l (70 and 140 mg/dl) during 24 h, but exenatide had a significantly greater effect (p < 0.05). More results showed that both treatments decreased postprandial serum glucagon, with exenatide having a greater effect (p < 0.005).

Both treatments decreased fasting blood glucose to a similar degree (p = 0.766). But, sitagliptin increased, while exenatide decreased, postprandial intact glucagon-like peptide-1. And both drugs improved homeostasis model assessment of β-cell function (HOMA-B), with exenatide having a significantly greater effect (p = 0.005).

Both exenatide and sitagliptin decreased 24-h caloric intake, with exenatide having a greater effect (p < 0.001). There was no episode of major hypoglycemia and adverse events were mild to moderate and mostly gastrointestinal in nature with exenatide. Plus, no study withdrawals were due to an adverse event.

Diabetes, Obesity and Metabolism, 10/12/2011