Combination therapy with insulin glargine and exenatide: Real-world outcomes in patients with type 2 diabetes

Philip Levin, Wenhui Wei, Li Wang, Chunshen Pan, Damon Douglas, Onur Baser

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)439-446
Number of pages8
JournalCurrent Medical Research and Opinion
Volume28
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Type 2 Diabetes Mellitus
Therapeutics
Insulin Glargine
exenatide
Insurance
Hypoglycemia
Cohort Studies
Retrospective Studies
Databases
Health
Pharmaceutical Preparations

Keywords

  • Exenatide
  • Insulin glargine
  • Real-world
  • Type 2 diabetes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Combination therapy with insulin glargine and exenatide : Real-world outcomes in patients with type 2 diabetes. / Levin, Philip; Wei, Wenhui; Wang, Li; Pan, Chunshen; Douglas, Damon; Baser, Onur.

In: Current Medical Research and Opinion, Vol. 28, No. 3, 03.2012, p. 439-446.

Research output: Contribution to journalArticle

Levin, Philip ; Wei, Wenhui ; Wang, Li ; Pan, Chunshen ; Douglas, Damon ; Baser, Onur. / Combination therapy with insulin glargine and exenatide : Real-world outcomes in patients with type 2 diabetes. In: Current Medical Research and Opinion. 2012 ; Vol. 28, No. 3. pp. 439-446.
@article{dc3c228881f34e368def44b944480feb,
title = "Combination therapy with insulin glargine and exenatide: Real-world outcomes in patients with type 2 diabetes",
abstract = "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.",
keywords = "Exenatide, Insulin glargine, Real-world, Type 2 diabetes",
author = "Philip Levin and Wenhui Wei and Li Wang and Chunshen Pan and Damon Douglas and Onur Baser",
year = "2012",
month = "3",
doi = "10.1185/03007995.2012.654850",
language = "English (US)",
volume = "28",
pages = "439--446",
journal = "Current Medical Research and Opinion",
issn = "0300-7995",
publisher = "Informa Healthcare",
number = "3",

}

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

VL - 28

SP - 439

EP - 446

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 0300-7995

IS - 3

ER -