TY - JOUR
T1 - Combination therapy with insulin glargine and exenatide
T2 - Real-world outcomes in patients with type 2 diabetes
AU - Levin, Philip
AU - Wei, Wenhui
AU - Wang, Li
AU - Pan, Chunshen
AU - Douglas, Damon
AU - Baser, Onur
PY - 2012/3
Y1 - 2012/3
N2 - Objective: To investigate the real-world use of combination insulin glargine/exenatide therapy for type 2 diabetes mellitus (T2DM) and associated treatment persistence and glycemic control. Methods: In this retrospective study, data were extracted from a national US insurance claims database for patients with T2DM for whom insulin glargine and exenatide were co-prescribed in differing order: insulin glargine added after exenatide (EXE+); exenatide added after insulin glargine (GLA+); glargine and exenatide initiated together (GLA+EXE). Patients had continuous health plan coverage for 6 months pre- (baseline) and 1-year post-index (follow-up). Results: A total of 453 patients were eligible for analysis: 141 patients were included in the EXE+cohort, 281 in the GLA+cohort, and 31 in the GLA+EXE cohort. There were significant differences between the groups at baseline, including a significantly lower A1C in the GLA+versus the EXE+cohort (p=0.0023). Around one third of patients stayed on both drugs up until the end of the follow-up period (GLA+: 30.2%; EXE+: 29.0%; GLA+EXE: 29.0%). However, more patients stayed on insulin glargine than on exenatide in each cohort. Significant A1C reductions were observed in each of the cohorts at follow-up: GLA+: -0.4%; EXE+: -0.9%; GLA+EXE: -1.2%; p<0.01, and were significantly higher in the GLA+EXE and EXE+cohorts than in the GLA+cohort (p=0.03 and p=0.002, respectively). The mean number of hypoglycemic events increased slightly from baseline but remained low in each of the cohorts (GLA+: 0.12 to 1.42; EXE+: 0.09 to 1.04; GLA+EXE: 0.23 to 1.87 per patient, all p>0.1). Conclusions: Combined therapy with insulin glargine and exenatide resulted in A1C reductions in T2DM patients with poor glycemic control without a significantly increased risk of hypoglycemia irrespective of treatment order. Limitations of this study are the between-cohort differences at baseline, lack of a comparator group, and small n number, particularly in the GLA+EXE cohort.
AB - Objective: To investigate the real-world use of combination insulin glargine/exenatide therapy for type 2 diabetes mellitus (T2DM) and associated treatment persistence and glycemic control. Methods: In this retrospective study, data were extracted from a national US insurance claims database for patients with T2DM for whom insulin glargine and exenatide were co-prescribed in differing order: insulin glargine added after exenatide (EXE+); exenatide added after insulin glargine (GLA+); glargine and exenatide initiated together (GLA+EXE). Patients had continuous health plan coverage for 6 months pre- (baseline) and 1-year post-index (follow-up). Results: A total of 453 patients were eligible for analysis: 141 patients were included in the EXE+cohort, 281 in the GLA+cohort, and 31 in the GLA+EXE cohort. There were significant differences between the groups at baseline, including a significantly lower A1C in the GLA+versus the EXE+cohort (p=0.0023). Around one third of patients stayed on both drugs up until the end of the follow-up period (GLA+: 30.2%; EXE+: 29.0%; GLA+EXE: 29.0%). However, more patients stayed on insulin glargine than on exenatide in each cohort. Significant A1C reductions were observed in each of the cohorts at follow-up: GLA+: -0.4%; EXE+: -0.9%; GLA+EXE: -1.2%; p<0.01, and were significantly higher in the GLA+EXE and EXE+cohorts than in the GLA+cohort (p=0.03 and p=0.002, respectively). The mean number of hypoglycemic events increased slightly from baseline but remained low in each of the cohorts (GLA+: 0.12 to 1.42; EXE+: 0.09 to 1.04; GLA+EXE: 0.23 to 1.87 per patient, all p>0.1). Conclusions: Combined therapy with insulin glargine and exenatide resulted in A1C reductions in T2DM patients with poor glycemic control without a significantly increased risk of hypoglycemia irrespective of treatment order. Limitations of this study are the between-cohort differences at baseline, lack of a comparator group, and small n number, particularly in the GLA+EXE cohort.
KW - Exenatide
KW - Insulin glargine
KW - Real-world
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=84863230184&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84863230184&partnerID=8YFLogxK
U2 - 10.1185/03007995.2012.654850
DO - 10.1185/03007995.2012.654850
M3 - Article
C2 - 22216894
AN - SCOPUS:84863230184
SN - 0300-7995
VL - 28
SP - 439
EP - 446
JO - Current Medical Research and Opinion
JF - Current Medical Research and Opinion
IS - 3
ER -