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Weekly Exenatide Superior to Glargine over Long Term

In the longest controlled clinical trial of exenatide compared with daily insulin glargine, investigators found better glycemic control and sustained weight loss for up to 84 weeks with once weekly exenatide (EQW).

Dr. Michaela Diamant of Vrije University Medical Center in Amsterdam and colleagues reported that, "This is the longest controlled clinical trial of EQW yet reported." The group previously reported positive 26-week results from an open-label, randomized trial of EQW vs. daily insulin glargine in 456 type 2 diabetics who were also taking metformin with or without a sulfonylurea.

In an online published paper, they report on 415 patients who completed the 26-week trial and entered an extension trial lasting up to 84 weeks. The baseline A1C of 8.3% decreased by -1.2% in the EQW arm and by -1.0% in the insulin glargine arm (p=0.029) at 84 weeks, the team found.

The endpoint A1C target of <7% was achieved by 44.6% in the glargine arm and 36.8% in the EQW arm (p=0.084). However, the difference in the proportion of patients achieving an A1C of 6.5% or less (31.3% vs. 20.6%, respectively) was significant (p=0.009).

Over the study period, body weight decreased by -2.1 kg in the EQW group but increased by 2.4 kg in the insulin group, the report indicates.

As for safety, rates of minor hypoglycemia were 24% with EQW and 54% with insulin glargine. Diarrhea occurred in 12% vs 6% of patients in the two arms, respectively, while corresponding rates of nausea were 15% versus 1%, Dr. Diamant and colleagues report.

They conclude, "EQW can be a therapeutic option for patients with type 2 diabetes for whom the convenience of once-a-week dosing, weight loss, and reduction of risk for hypoglycemia are important."

Diabetes Care Online February 22, 2012