Exenatide plus pioglitazone effective, safe in T2DM patients with very high HbA1c
The combination of exenatide and pioglitazone appears to be an effective and safe treatment option in patients with poorly controlled type 2 diabetes mellitus (T2DM) with very high haemoglobin A1c (HbA1c; >10 percent) receiving sulfonylurea plus metformin, according to a new study.
Researchers examined the efficacy and safety of combination therapy with exenatide plus pioglitazone vs basal/bolus insulin.
A total of 101 participants in the Qatar Study with very poor glycaemic control (HbA1c >10 percent) and a long duration of diabetes (10.9 years) receiving maximum or near-maximum doses of sulfonylurea plus metformin were randomly assigned to receive either pioglitazone plus weekly exenatide (combination therapy) or basal plus prandial insulin (insulin therapy) to maintain HbA1c <7.0 percent.
Patients in the combination therapy had a baseline HbA1c of 11.5 percent and 11.2 percent among those in the insulin therapy group.
A robust decrease in HbA1c occurred in patients assigned to the combination therapy (6.7 percent; ∆=−4.8 percent) compared with those receiving insulin therapy (7.4 percent; ∆=−3.8 percent) at 6 months. Combination therapy effectively reduces the HbA1c in T2DM patients independent of sex, ethnicity or body mass index.
Furthermore, participants in the insulin therapy group had significantly greater weight gain as well as a 2.5-fold higher rate of hypoglycaemia compared with those receiving combination therapy.
These results support a previous study, which found that combination therapy with metformin/pioglitazone/exenatide in patients with newly diagnosed T2DM is more effective and results in fewer hypoglycaemic events than sequential add-on therapy with metformin, sulfonylurea and then basal insulin. [Diabetes Obes Metab 2015;17:268-75]