Achieving CV Goals with Weekly Exenatide vs. Sitagliptin or Glargine

Once-weekly exenatide shows benefit in type 2 diabetes patients…. 

Research has shown that patients with diabetes are at a higher risk for cardiovascular (CV) complications. Previous studies (ADVANCE, ACCORD, UKPDS, DCCT, and others) have shown that control of additional CV risk factors in addition to intensive glycemic control may reduce CV events and microvascular complications by about 50%. As a result, the American Diabetes Association (ADA) has published guideline goals for glycemic control to reduce the risk for CV events in patients with type 2 diabetes.

This retrospective analysis examined the absolute benefit increase (ABI) of exenatide once-weekly (QW) dosing versus oral hypoglycemic medications sitagliptin and pioglitazone or insulin glargine in order to meet ADA goals. Three randomized, double-blind, controlled trials of 26 weeks duration were included in an intent-to-treat (ITT) analysis (DURATION-2, -3, and -4). Variables measured included HbA1C, systolic blood pressure (SBP), and low-density lipoprotein (LDL). The purpose of the study was to compare the effect of exenatide QW dosing versus other commonly prescribed glucose-lowering medications on the ABI and number needed to treat (NNT) to reach ADA goals.

Significantly more type 2 diabetic patients taking exenatide QW reached desired HbA1C goals of <7.0% (or ≤ 6.5%), SBP <130mmHg, and LDL <2.59 mmol/L, as compared to patients on sitagliptin and insulin glargine. Notably, greater numbers of patients taking exenatide QW reached target HbA1C goals without experiencing weight gain or hypoglycemia as compared to sitagliptin, pioglitazone, and insulin glargine.

Common barriers to improved glycemic control may include hypoglycemia and weight gain, which negatively impact patient quality of life (QoL) and may lead to further CV risk factors. Exenatide is a glucagon-like peptide-1 (GLP-1) receptor agonist, which not only reduces blood glucose but may also help patients lose weight. Since this study shows exenatide once weekly dosing to be more effective than some conventional therapies in achieving ADA goals, this may be a good choice for diabetic patients with CV risk factors seeking to reach therapeutic goals.

• Management of type 2 diabetes should focus on both short and long term control of blood glucose and CV risk factors.
• Exenatide once weekly dosing is a GLP-agonist that helps lower blood glucose with less hypoglycemia and may cause weight loss.
• Exenatide once weekly has been shown more effective in helping type 2 diabetic patients reach ADA-recommended HbA1C, SBP and LDL goals as compared to other commonly used agents such as sitagliptin and insulin glargine.

Meloni et al. Treatment of patients with type 2 diabetes with exenatide once weekly versus oral glucose-lowering medications or insulin glargine: achievement of glycemic and cardiovascular goals. Cardiovascular Diabetology 2013;12:48.