We sought to evaluate the difference in HbA1c (primary outcome), body mass index (BMI), and body weight in veterans with type 2 diabetes (T2DM) prescribed exenatide twice daily (BID) versus long-acting insulin analogs (LAIA) at two years after initiation.
Method:
Retrospective observational cohort study investigating exenatide and LAIA (glargine and detemir) in a veteran population over 2 years. Patients were included if >/=18 years, eligible for veterans benefits, and on first prescription fill with exenatide or LAIA at the Veterans Health Administration (VHA) between January 1, 2006 to December 31, 2010. Patients were excluded if prescribed both medications during the follow-up period, crossed over into the other group, did not have a visit within the 1 year prior to index date, and did not have 2 years follow-up. Clinical data were extracted from the VHA Corporate Data Warehouse. Main dependent variables included HbA1c, BMI and body weight change from baseline at 2 years. Generalized linear models evaluated change in HbA1c, BMI, and body weight controlling for potential confounders. Logistic regression evaluated a >/=0.5% HbA1c reduction stratified by baseline HbA1c categories: Low, <7%; Moderate, 7% to <9 %; and High, >/=9%.
Result:
A total of 446 exenatide and 51,531 LAIA patients were identified as receiving their first prescription fill during the index date. On average exenatide patients were older (64 versus 60 years), heavier (261.9 versus 225.9 pounds), had a higher BMI (37.8 versus 32.9 kg/m2), and lower Charlson Comorbidity Index (1.7 versus 1.8). Baseline HbA1c was 8.2% and 8.8% for exenatide and LAIA patients, respectively (p <0.0001). Patients in both groups had similar lipid profiles, starting medication count, and the following comorbidities: ophthalmic, renal, neurologic, depression, mental health, and hypertension. Exenatide treatment was associated with a 0.32% (95% CI: 0.18%, 0.47%) reduction in HbA1c at 2 years compared to LAIA, controlling for potential confounders. Similar findings were observed with BMI (0.68 kg/m2; 95% CI: 0.42, 0.95 kg/m2) and weight (4.8 lbs; 95% CI: 3.0, 6.6 lbs) reduction. In the logistic regression, exenatide patients who had moderate baseline HbA1c had higher odds of achieving >/=0.5% HbA1c reduction compared to LAIA patients (OR=1.5; 95% CI: 1.2, 2.0).
Conclusion:
Veterans treated with exenatide had significantly greater reduction in HbA1c, BMI and body weight compared to LAIA patients.