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Retrospective cohort study evaluating exenatide twice daily and long-acting insulin analogs in a Veterans Health Administration population with type 2 diabetes - 17/09/14

Doi : 10.1016/j.diabet.2014.06.002 
M. Bounthavong a, , J.N. Tran b , S. Golshan c , N.F. Piland d , C.M. Morello e , A. Blickensderfer f , J.H. Best g, h
a Veterans Affairs San Diego Healthcare System, San Diego, USA 
b Clinical Analytics and Outcomes Research, OptumRX, Irvine, CA, USA 
c Advanced Center for Innovation in Services and Intervention Research (ACISIR), University of California, Department of Psychiatry, San Diego, CA, USA 
d Idaho State University, Institute of Rural Health, Pocatello, Idaho, USA 
e UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California, USA 
f Medical Relations & Information, Amylin Pharmaceuticals, LLC., a fully-owned subsidiary of Bristol-Myers Squibb, San Diego, California, USA 
g Health Outcomes, Amylin Pharmaceuticals, LLC., a fully-owned subsidiary of Bristol-Myers Squibb, San Diego, California, USA 
h University of Washington, Seattle, Washington, USA 

Corresponding author. Tel.: +858 642 3158.

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Abstract

Aim

This was a retrospective cohort study that evaluated the differences in glycated haemoglobin (HbA1c) and body mass index (BMI) in veterans with type 2 diabetes mellitus (T2DM), prescribed exenatide twice daily (BID) versus long-acting insulin analog (LAIA) two years after initiation in the United States (US) veteran population.

Materials and methods

Patients were included if they were18 years old with T2DM, and initiated exenatide BID or LAIA at the Veterans Health Administration between January 1, 2006 and December 31, 2010. Multivariate models were used to evaluate the changes in HbA1c and BMI between groups, controlling for potential confounders. Logistic regression was used to evaluate the odds of achieving0.5% HbA1c reduction based on baseline HbA1c stratifications: low,<7%; moderate, 7% to<9%; and high,9%.

Results

A total of 446 exenatide BID and 51,531 LAIA patients met inclusion/exclusion criteria. On average, exenatide BID patients were significantly older (64 versus 60 years) with a higher BMI (37.8 versus 32.9kg/m2). Baseline HbA1c was 8.2% and 8.8% for exenatide BID and LAIA patients, respectively (P<0.001); otherwise, patients were similar for all other characteristics. Exenatide BID treatment was significantly associated with a 0.32% (95%CI: 0.18–0.47%) greater reduction in HbA1c at two years compared with LAIA. Similar findings were observed for BMI reduction (0.68kg/m2; 95%CI: 0.42–0.95kg/m2). Exenatide BID patients with moderate baseline HbA1c had significantly higher odds of achieving0.5% HbA1c reduction compared with LAIA patients (OR=1.5; 95%CI: 1.2–2.0).

Conclusions

Veterans treated with exenatide BID had significantly greater reduction in HbA1c and BMI compared with patients treated with LAIA patients two years after initiation.

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Keywords : Exenatide, Type 2 diabetes, Long-acting insulin analogs, Glargine, Detemir, Retrospective cohort, Pharmacoepidemiology, Veterans


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© 2014  Publicado por Elsevier Masson SAS.
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Vol 40 - N° 4

P. 284-291 - septembre 2014 Regresar al número
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