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Effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the United States

AIM: To evaluate the effectiveness and tolerability of exenatide once weekly (EQW) compared with basal insulin (BI) among injectable‐drug‐naïve patients with type 2 diabetes mellitus (T2DM) who are elderly or have renal impairment (RI). MATERIALS AND METHODS: Initiators of EQW and BI with T2DM were...

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Autores principales: Loughlin, Anita M., Qiao, Qing, Nunes, Anthony P., Öhman, Peter, Ezzy, Stephen, Yochum, Laura, Clifford, C. Robin, Gately, Robert, Dore, David D., Seeger, John D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873410/
https://www.ncbi.nlm.nih.gov/pubmed/29193561
http://dx.doi.org/10.1111/dom.13175
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author Loughlin, Anita M.
Qiao, Qing
Nunes, Anthony P.
Öhman, Peter
Ezzy, Stephen
Yochum, Laura
Clifford, C. Robin
Gately, Robert
Dore, David D.
Seeger, John D.
author_facet Loughlin, Anita M.
Qiao, Qing
Nunes, Anthony P.
Öhman, Peter
Ezzy, Stephen
Yochum, Laura
Clifford, C. Robin
Gately, Robert
Dore, David D.
Seeger, John D.
author_sort Loughlin, Anita M.
collection PubMed
description AIM: To evaluate the effectiveness and tolerability of exenatide once weekly (EQW) compared with basal insulin (BI) among injectable‐drug‐naïve patients with type 2 diabetes mellitus (T2DM) who are elderly or have renal impairment (RI). MATERIALS AND METHODS: Initiators of EQW and BI with T2DM were identified for the period 2012 to 2015 within a US electronic health record database and matched by propensity score. Matched EQW and BI initiators aged ≥65 years or who had RI were compared. Data on weight, glycated haemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), blood pressure and lipids were obtained at baseline and quarterly (Q1–Q4) or semi‐annually for 1 year after drug initiation. Hypoglycaemia and gastrointestinal symptoms were identified using diagnosis codes and data abstracted from clinical notes. RESULTS: Among patients aged ≥65 years, HbA1c changed by −0.50 and −0.31 percentage points from baseline to Q4 for EQW and BI initiators, respectively. Weight changed by −1.6 kg among EQW initiators compared with 0.2 kg among BI initiators. Compared with BI initiators, EQW initiators had a 1.45‐fold increased risk of nausea and vomiting. Among patients with RI, HbA1c changed by −0.58 and −0.33 percentage points from baseline to Q4 for EQW and BI initiators, respectively. Weight changed by −1.9 kg for EQW initiators while BI initiators had no change in weight. EQW initiators had a 1.28‐fold increased risk of constipation and diarrhoea compared with BI initiators. CONCLUSION: Regardless of age or renal function, the benefits of EQW relative to BI treatment are improved glycaemic control and increased weight loss, which should be weighed against the increased risk of gastrointestinal symptoms.
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spelling pubmed-58734102018-03-31 Effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the United States Loughlin, Anita M. Qiao, Qing Nunes, Anthony P. Öhman, Peter Ezzy, Stephen Yochum, Laura Clifford, C. Robin Gately, Robert Dore, David D. Seeger, John D. Diabetes Obes Metab Original Articles AIM: To evaluate the effectiveness and tolerability of exenatide once weekly (EQW) compared with basal insulin (BI) among injectable‐drug‐naïve patients with type 2 diabetes mellitus (T2DM) who are elderly or have renal impairment (RI). MATERIALS AND METHODS: Initiators of EQW and BI with T2DM were identified for the period 2012 to 2015 within a US electronic health record database and matched by propensity score. Matched EQW and BI initiators aged ≥65 years or who had RI were compared. Data on weight, glycated haemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), blood pressure and lipids were obtained at baseline and quarterly (Q1–Q4) or semi‐annually for 1 year after drug initiation. Hypoglycaemia and gastrointestinal symptoms were identified using diagnosis codes and data abstracted from clinical notes. RESULTS: Among patients aged ≥65 years, HbA1c changed by −0.50 and −0.31 percentage points from baseline to Q4 for EQW and BI initiators, respectively. Weight changed by −1.6 kg among EQW initiators compared with 0.2 kg among BI initiators. Compared with BI initiators, EQW initiators had a 1.45‐fold increased risk of nausea and vomiting. Among patients with RI, HbA1c changed by −0.58 and −0.33 percentage points from baseline to Q4 for EQW and BI initiators, respectively. Weight changed by −1.9 kg for EQW initiators while BI initiators had no change in weight. EQW initiators had a 1.28‐fold increased risk of constipation and diarrhoea compared with BI initiators. CONCLUSION: Regardless of age or renal function, the benefits of EQW relative to BI treatment are improved glycaemic control and increased weight loss, which should be weighed against the increased risk of gastrointestinal symptoms. Blackwell Publishing Ltd 2018-01-03 2018-04 /pmc/articles/PMC5873410/ /pubmed/29193561 http://dx.doi.org/10.1111/dom.13175 Text en © 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Loughlin, Anita M.
Qiao, Qing
Nunes, Anthony P.
Öhman, Peter
Ezzy, Stephen
Yochum, Laura
Clifford, C. Robin
Gately, Robert
Dore, David D.
Seeger, John D.
Effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the United States
title Effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the United States
title_full Effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the United States
title_fullStr Effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the United States
title_full_unstemmed Effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the United States
title_short Effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the United States
title_sort effectiveness and tolerability of therapy with exenatide once weekly vs basal insulin among injectable‐drug‐naïve elderly or renal impaired patients with type 2 diabetes in the united states
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873410/
https://www.ncbi.nlm.nih.gov/pubmed/29193561
http://dx.doi.org/10.1111/dom.13175
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