Combination Therapy With Exenatide Plus Pioglitazone Versus Basal/Bolus Insulin in Patients With Poorly Controlled Type 2 Diabetes on Sulfonylurea Plus Metformin: The Qatar Study.

Abstract

OBJECTIVE:

The Qatar Study was designed to examine the efficacy of combination therapy with exenatide plus pioglitazone versus basal/bolus insulin in patients with long-standing poorly controlled type 2 diabetes mellitus (T2DM) on metformin plus a sulfonylurea.

RESEARCH DESIGN AND METHODS:

The study randomized 231 patients with poorly controlled (HbA1c >7.5%, 58 mmol/mol) T2DM on a sulfonylurea plus metformin to receive 1) pioglitazone plus weekly exenatide (combination therapy) or 2) basal plus prandial insulin (insulin therapy) to maintain HbA1c <7.0% (53 mmol/mol).

RESULTS:

After a mean follow-up of 12 months, combination therapy caused a robust decrease in HbA1c from 10.0 ± 0.6% (86 ± 5.2 mmol/mol) at baseline to 6.1 ± 0.1% (43 ± 0.7 mmol/mol) compared with 7.1 ± 0.1% (54 ± 0.8 mmol/mol) in subjects receiving insulin therapy. Combination therapy was effective in lowering the HbA1c independent of sex, ethnicity, BMI, or baseline HbA1c. Subjects in the insulin therapy group experienced significantly greater weight gain and a threefold higher rate of hypoglycemia than patients in the combination therapy group.

CONCLUSIONS:

Combination exenatide/pioglitazone therapy is a very effective and safe therapeutic option in patients with long-standing poorly controlled T2DM on metformin plus a sulfonylurea.

• Authors: Muhammad Abdul-Ghani, Osama Migahid, Ayman Megahed, John Adams, Curtis Triplitt, Ralph A DeFronzo, Mahmoud Zirie, Amin Jayyousi
• Journal: Diabetes care (Diabetes Care) Vol. 40 Issue 3 Pg. 325-331 (Mar 2017) ISSN: 1935-5548 [Electronic] United States
• PMID: 28096223 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2017 by the American Diabetes Association.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• Peptides
• Sulfonylurea Compounds
• Thiazolidinediones
• Venoms
• Metformin
• Exenatide
• Pioglitazone

Topics

• Blood Glucose (metabolism)
• Diabetes Mellitus, Type 2 (drug therapy)
• Drug Therapy, Combination
• Exenatide
• Female
• Follow-Up Studies
• Glycated Hemoglobin (metabolism)
• Humans
• Hypoglycemia (blood, etiology)
• Hypoglycemic Agents (administration & dosage, therapeutic use)
• Insulin (therapeutic use)
• Male
• Metformin (therapeutic use)
• Middle Aged
• Peptides (administration & dosage, therapeutic use)
• Pioglitazone
• Qatar
• Sulfonylurea Compounds (therapeutic use)
• Thiazolidinediones (administration & dosage, therapeutic use)
• Venoms (administration & dosage, therapeutic use)
• Weight Gain