A CME Journal For Family Physicians

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Alternative to Insulin Is Effective for Type 2 Diabetes Patients With High HBA1c

Treatment with exenatide is associated with improved glycemic control among individuals with type 2 diabetes with a high hemoglobin A1c (HbA1c) level, indicating that exenatide may be a suitable alternative to insulin in some patients, according to a recent analysis.
Treating individuals with advanced type 2 diabetes and high glycated HbA1c values can be difficult due to their 
severe metabolic disease.
For their analysis, the researchers assessed data from 12 randomized controlled trials (RCTs) of exenatide twice daily and 8 RCTs of exenatide once weekly. Patients with type 2 diabetes who had completed at least 24 weeks of treatment with exenatide twice daily, exenatide once weekly, or insulin—including insulin glargine, insulin detemir, or insulin aspart—were included in the analysis and were categorized according to baseline HbA1c. High HbA1c was defined as 10% or higher.
Results indicated that exenatide and insulin had both reduced HbA1c by 2.0% and 2.1%, respectively, in the studies of exenatide twice daily and by 2.6% and 2.1%, respectively, in the studies of exenatide once weekly.
The researchers noted that body weight had decreased with exenatide use but had increased with insulin use. Exenatide once weekly was associated with a decrease in systolic blood pressure. Insulin dose had increased throughout the course of treatment.
Gastrointestinal events were the most common adverse events with exenatide use. Insulin use was associated with some risk for hypoglycemia. Exenatide use without sulphonylureas was associated with infrequent hypoglycemia events.
“For patients with high HbA1c, treatment with exenatide or insulin both improved glycemic control,” the researchers concluded. “Given the associated weight loss and low risk of hypoglycaemia, exenatide may be a suitable alternative to treatment with insulin in certain patients with [type 2 diabetes] and high HbA1c.”

REFERENCE
Busch RS, Ruggles J, Han J, Hardy E. Effects of exenatide twice daily, exenatide once weekly or insulin in patients with type 2 diabetes and baseline HbA1c ≥10.0%: two pooled analyses including 20 randomised controlled trials [Published online October 17, 2017]. Int J Clin Pract.doi:10.1111/ijcp.13029.

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