Real-world clinical responses in patients with type 2 diabetes mellitus adding exenatide BID (EBID) or mealtime insulin to basal insulin: a retrospective study using electronic medical record data

Kathleen Lang, Hiep Nguyen, Huan Huang, Elise Bauer, Philip Levin

Research output: Contribution to journalArticle

Abstract

Aim: Exenatide twice daily (EBID) and mealtime insulin are effective add-on therapies to basal insulin for type 2 diabetes patients in clinical trials. This study used electronic medical record (EMR) data to evaluate analogous real-world clinical responses. Materials and methods: Adult patients initiating EBID or mealtime insulin as add-on to basal insulin during January 2008–March 2013 were identified in a US EMR database. EBID patients were propensity score matched 1:1 to mealtime insulin patients. Cohorts were followed for 12 months before (baseline) and 6 months after the index. A1C, hypoglycemic events, change in weight, and other clinical measures were evaluated by A1C attainment level (<6.5, < 7, < 7.5, <8, <9%) and baseline A1C. Results: In total, 1249 EBID patients were matched to 1249 mealtime insulin patients. During follow-up, the percentage reaching A1C levels was similar for EBID vs mealtime insulin cohorts for all attainment levels (<7%: 27.8% vs 24.2%; < 9%: 79.7% vs 79.2%; p = NS). The percentage reaching A1C < 7% was similar for both cohorts with different baseline A1C. EBID patients had less hypoglycemia at all attainment levels (3.1% vs 11.1% [<6.5%]; 2.5% vs 4.7% [<9%]; all p < .03) and more weight loss (–9.0 vs –3.2 lb [<6.5%]; –3.4 vs +0.8 lb [<9%]; all p < .01). Conclusions: EBID added to basal insulin was as effective in a real-world setting as mealtime insulin added to basal insulin in reducing A1C, with less weight gain and less hypoglycemia for a wide range of A1C attainment levels and baseline values.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalCurrent Medical Research and Opinion
DOIs
StateAccepted/In press - Mar 1 2018
Externally publishedYes

Fingerprint

Electronic Health Records
Type 2 Diabetes Mellitus
Meals
Retrospective Studies
Insulin
Hypoglycemia
exenatide
Propensity Score
Hypoglycemic Agents
Weight Gain
Weight Loss
Clinical Trials
Databases
Weights and Measures

Keywords

  • basal insulin
  • electronic medical record data
  • Exenatide
  • mealtime insulin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Real-world clinical responses in patients with type 2 diabetes mellitus adding exenatide BID (EBID) or mealtime insulin to basal insulin: a retrospective study using electronic medical record data",
abstract = "Aim: Exenatide twice daily (EBID) and mealtime insulin are effective add-on therapies to basal insulin for type 2 diabetes patients in clinical trials. This study used electronic medical record (EMR) data to evaluate analogous real-world clinical responses. Materials and methods: Adult patients initiating EBID or mealtime insulin as add-on to basal insulin during January 2008–March 2013 were identified in a US EMR database. EBID patients were propensity score matched 1:1 to mealtime insulin patients. Cohorts were followed for 12 months before (baseline) and 6 months after the index. A1C, hypoglycemic events, change in weight, and other clinical measures were evaluated by A1C attainment level (<6.5, < 7, < 7.5, <8, <9{\%}) and baseline A1C. Results: In total, 1249 EBID patients were matched to 1249 mealtime insulin patients. During follow-up, the percentage reaching A1C levels was similar for EBID vs mealtime insulin cohorts for all attainment levels (<7{\%}: 27.8{\%} vs 24.2{\%}; < 9{\%}: 79.7{\%} vs 79.2{\%}; p = NS). The percentage reaching A1C < 7{\%} was similar for both cohorts with different baseline A1C. EBID patients had less hypoglycemia at all attainment levels (3.1{\%} vs 11.1{\%} [<6.5{\%}]; 2.5{\%} vs 4.7{\%} [<9{\%}]; all p < .03) and more weight loss (–9.0 vs –3.2 lb [<6.5{\%}]; –3.4 vs +0.8 lb [<9{\%}]; all p < .01). Conclusions: EBID added to basal insulin was as effective in a real-world setting as mealtime insulin added to basal insulin in reducing A1C, with less weight gain and less hypoglycemia for a wide range of A1C attainment levels and baseline values.",
keywords = "basal insulin, electronic medical record data, Exenatide, mealtime insulin",
author = "Kathleen Lang and Hiep Nguyen and Huan Huang and Elise Bauer and Philip Levin",
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language = "English (US)",
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T1 - Real-world clinical responses in patients with type 2 diabetes mellitus adding exenatide BID (EBID) or mealtime insulin to basal insulin

T2 - a retrospective study using electronic medical record data

AU - Lang, Kathleen

AU - Nguyen, Hiep

AU - Huang, Huan

AU - Bauer, Elise

AU - Levin, Philip

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Aim: Exenatide twice daily (EBID) and mealtime insulin are effective add-on therapies to basal insulin for type 2 diabetes patients in clinical trials. This study used electronic medical record (EMR) data to evaluate analogous real-world clinical responses. Materials and methods: Adult patients initiating EBID or mealtime insulin as add-on to basal insulin during January 2008–March 2013 were identified in a US EMR database. EBID patients were propensity score matched 1:1 to mealtime insulin patients. Cohorts were followed for 12 months before (baseline) and 6 months after the index. A1C, hypoglycemic events, change in weight, and other clinical measures were evaluated by A1C attainment level (<6.5, < 7, < 7.5, <8, <9%) and baseline A1C. Results: In total, 1249 EBID patients were matched to 1249 mealtime insulin patients. During follow-up, the percentage reaching A1C levels was similar for EBID vs mealtime insulin cohorts for all attainment levels (<7%: 27.8% vs 24.2%; < 9%: 79.7% vs 79.2%; p = NS). The percentage reaching A1C < 7% was similar for both cohorts with different baseline A1C. EBID patients had less hypoglycemia at all attainment levels (3.1% vs 11.1% [<6.5%]; 2.5% vs 4.7% [<9%]; all p < .03) and more weight loss (–9.0 vs –3.2 lb [<6.5%]; –3.4 vs +0.8 lb [<9%]; all p < .01). Conclusions: EBID added to basal insulin was as effective in a real-world setting as mealtime insulin added to basal insulin in reducing A1C, with less weight gain and less hypoglycemia for a wide range of A1C attainment levels and baseline values.

AB - Aim: Exenatide twice daily (EBID) and mealtime insulin are effective add-on therapies to basal insulin for type 2 diabetes patients in clinical trials. This study used electronic medical record (EMR) data to evaluate analogous real-world clinical responses. Materials and methods: Adult patients initiating EBID or mealtime insulin as add-on to basal insulin during January 2008–March 2013 were identified in a US EMR database. EBID patients were propensity score matched 1:1 to mealtime insulin patients. Cohorts were followed for 12 months before (baseline) and 6 months after the index. A1C, hypoglycemic events, change in weight, and other clinical measures were evaluated by A1C attainment level (<6.5, < 7, < 7.5, <8, <9%) and baseline A1C. Results: In total, 1249 EBID patients were matched to 1249 mealtime insulin patients. During follow-up, the percentage reaching A1C levels was similar for EBID vs mealtime insulin cohorts for all attainment levels (<7%: 27.8% vs 24.2%; < 9%: 79.7% vs 79.2%; p = NS). The percentage reaching A1C < 7% was similar for both cohorts with different baseline A1C. EBID patients had less hypoglycemia at all attainment levels (3.1% vs 11.1% [<6.5%]; 2.5% vs 4.7% [<9%]; all p < .03) and more weight loss (–9.0 vs –3.2 lb [<6.5%]; –3.4 vs +0.8 lb [<9%]; all p < .01). Conclusions: EBID added to basal insulin was as effective in a real-world setting as mealtime insulin added to basal insulin in reducing A1C, with less weight gain and less hypoglycemia for a wide range of A1C attainment levels and baseline values.

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KW - electronic medical record data

KW - Exenatide

KW - mealtime insulin

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