Friday, March 9, 2012

Lose Weight , control glucose with one shot a week

The article abstract below from PubMed provides more reasons for choosing once -weekly exenatide.  The once weekly Exenatide( Byetta) in various combination with metformin and sulfonylureas had less hypoglycemia , more weight loss and equivalent A1c reduction . 

                                                    A1c                     weight
  Exenatide once weekly        decreased 1.3             decreased 2.1 kg( 4.6 pounds )
  Lantus insulin                      decreased  1. 0           increased  2,4 kg (5.2 pounds)

                                                                        Hypoglycemia (mild )
  Exenatide  plus metformin                                       8%
  Exenatide/metformin/ sulfonylurea                       24%

  Lantus insulin plus metformim                               32%
  Lantus insulin/ metformin / sulfonylurea               54%

Comment - this article adds more support to the idea of retiring sulfonylureas  and supports the use of Exenatide ( Byetta) once weekly and metformin (glucophage ) as the best choice of medications for someone with type 2 diabetes . 

Have fun , Be Smart  and defeat Diabetes
David Calder,MD

Diabetes Care. 2012 Feb 22. [Epub ahead of print]

Safety and Efficacy of Once-Weekly Exenatide Compared With Insulin Glargine Titrated to Target in Patients With Type 2 Diabetes Over 84 Weeks.


Diabetes Center, Vrije University Medical Center, Amsterdam, the Netherlands.


OBJECTIVEWe recently reported that after 26 weeks, exenatide once weekly (EQW) resulted in superior A1C reduction, reduced hypoglycemia, and progressive weight loss compared with daily insulin glargine (IG) in patients with type 2 diabetes who were taking metformin alone or with sulfonylurea. This 84-week extension study assessed the long-term safety and efficacy of EQW versus IG.RESEARCH DESIGN AND METHODSThis multicenter, open-label, randomized, two-arm, parallel trial assessed change in A1C, proportions of patients achieving A1C <7.0 and ≤6.5%, body weight, incidence of hypoglycemia, and overall safety.RESULTSOf 415 patients who completed 26 weeks, 390 (194 EQW and 196 IG patients) entered the extension study. At 84 weeks, A1C decreased from baseline (8.3%) by -1.2% for EQW vs. -1.0% for IG (P = 0.029). The proportions of patients who achieved end point A1C targets <7.0 and ≤6.5% were 44.6% for EQW patients vs. 36.8% for IG patients (P = 0.084) and 31.3% for EQW patients vs. 20.2% for IG patients (P = 0.009), respectively. Patients taking EQW lost 2.1 kg of body weight, whereas those taking IG gained 2.4 kg (P < 0.001). Among patients taking metformin plus sulfonylurea, the incidence of minor hypoglycemia was 24% for EQW patients vs. 54% for IG patients (P < 0.001); among patients taking metformin alone, it was 8% for EQW patients vs. 32% for IG patients (P < 0.001). Among adverse events occurring in ≥5% of patients, diarrhea and nausea occurred more frequently (P < 0.05) in the EQW group than in the IG group (12 vs. 6% and 15 vs. 1%, respectively).CONCLUSIONSAfter 84 weeks, patients treated with EQW continued to experience better glycemic control with sustained overall weight loss and a lower risk of hypoglycemia than patients treated with IG.
[PubMed - as supplied by publisher]

1 comment:

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Your comments and questions are appreciated. David Calder,MD