With all the available treatment options for type 2 diabetes, it can be hard to tell which one is right for which patient. A recent study addressed this difficulty with a comparison of two medications.
Researchers found that exenatide (marketed at Byetta and Bydureon) may be a better option for managing type 2 diabetes than insulin detemir.
Results showed that patients taking exenatide had greater reductions in both blood sugar levels and weight, compared to those taking insulin detemir.
Melanie Davies, MBCHB, MD, FRCP, of the University of Leicester, and colleagues compared the safety and effectiveness of exenatide once weekly with insulin detemir in patients with type 2 diabetes that was not controlled enough with metformin (the first-line drug for diabetes).
Insulin is a natural hormone that helps the body turn sugar in the blood (glucose) into energy for the body. In people with diabetes, the body either does not make enough insulin or does not use insulin properly. For this reason, patients must take additional insulin or other medications.
Insulin detemir is a long-acting insulin that works slowly over the course of the day to control blood sugar levels. Exenatide is an injected medication used to control blood sugar.
In the study, 111 diabetes patients took exenatide once weekly and 105 took insulin detemir. The researchers wanted to see how many patients from each group were able to achieve HbA1c levels of 7 percent or less.
HbA1c is a measure of blood sugar levels over the past 3 months. A HbA1c of less than 5.7 percent is considered normal. People with levels of 6.5 percent or higher are said to have diabetes. Typically, people with diabetes are told to keep their levels at or below 7 percent.
Results from the study showed that 44.1 percent of patients treated with exenatide achieved a HbA1c of 7 percent or less. In comparison, only 11.4 percent of patients taking insulin detemir achieved the same goal.
Patients treated with exenatide reduced their HbA1c by about 1.3 percent while detemir-treated patients reduced their HbA1c by about 0.88 percent.
In addition, patients treated with exenatide lost about 6 pounds, while patients treated with detemir gained about 1.8 pounds.
Even though exenatide led to greater improvements in blood sugar and weight, patients taking the drug also had more negative side effects, particularly gastrointestinal and injection site-related events.
The two treatment groups had similarly low rates of minor hypoglycemia, or dangerously low blood sugar (6 percent of exenatide group versus 7 percent of detemir group).
Controlling blood sugar and weight is crucial to properly managing diabetes.
According to the authors, "Treatment with exenatide once weekly resulted in a significantly greater proportion of patients achieving target [HbA1c] and weight loss than treatment with detemir, with a low risk of hypoglycemia. These results suggest that exenatide once weekly is a viable alternative to insulin detemir treatment in patients with type 2 diabetes with inadequate [blood sugar] control using oral antidiabetes drugs."
The study was published December 28 in Diabetes Care, a journal of the American Diabetes Association. The study was sponsored by Amylin Pharmaceuticals, the manufacturer of Byetta and Bydureon, in collaboration with Eli Lilly and Company.