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EASD: Once-Weekly Exenatide Provides Better Control Then Twice Daily

Sep 16, 2008

Type 2 diabetes patients treated with a once-weekly version of the incretin mimetic exenatide (Byetta) had better glycemic control than those given the injections twice a day, the standard approach, showed findings published online by The Lancet.

Moreover, there was no increased risk of hypoglycemia, and reductions in bodyweight mirrored those seen with standard dosing, said Daniel J. Drucker, M.D., of the University of Toronto.

Dr. Drucker first reported results of the 30-week, open-label, non-inferiority trial at the American Diabetes Association meeting in June. (See: ADA: No Efficacy or Safety Sacrifice with Weekly Exenatide (Byetta))

The 30-week trial recruited 295 patients with type 2 diabetes. Patients were evenly randomized to a once-weekly injection of long-acting exenatide (2 mg) or twice-daily injections (10 µg). At baseline the mean HbA1c was 8.3%, mean fasting plasma glucose was 9 mmol/L, and average weight was 102 kg. Patients had diabetes for an average of seven years.

Patients had an average reduction of 1.9 percentage points in HbAIc during 30 weeks of treatment with weekly exenatide, compared with a 1.5-point decline in 147 patients receiving twice-a-day doses of the standard drug (P<0.0023), Dr. Drucker wrote.

Moreover, 77% of patients taking the long-acting exenatide had HbA1c levels of 7 % or less versus 61% of patients in the standard therapy arm (P=0.0039).

Body weight decreased by 3.7% among patients who received the once-weekly injection and 3.6% among patients who received standard-dose exenatide.

But Dr. Scheen concluded that a once-a week treatment "could favorably and durably affect the control of basal and postprandial glucose, which results from an exquisite continuous timely feedback loop."

Drucker DJ "Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomized, open-label, non-inferiority study" Lancet 2008; DOI: 10.1016/S0140-6736(08)61206-4.


Early control of diabetes reduces later complications:  A study has found that people with diabetes who control their blood sugar have lower risk of complications such as heart attacks and death even 10 years later. The study, a follow-up study published online Wednesday in the New England Journal of Medicine, involved 3,277 people who had participated in a previous study of 4,209 newly diagnosed diabetics. The follow-up study tracked the patients for 10 years through clinic visits and then questionnaires. Within a year of the end of the original study, differences in blood sugar control between a group instructed to take diabetes drugs and a group instructed to restrict diet disappeared. The group that took drugs reduced its risk of heart attack by 15 to 33 percent and its risk of death by 13 to 27 percent, depending on which drug it used.  See This Weeks’ Item #1


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