Heine RJ et al. (2005) Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes. Ann Intern Med 143: 559–569

In an open-label phase III trial, Heine et al. have compared the effects of exenatide and insulin glargine in patients with type 2 diabetes whose blood glucose levels were inadequately controlled with combination metformin and sulfonylurea therapy.

Patients were randomized to receive exenatide (n = 282) or insulin glargine (n = 267). Inclusion criteria included an age of between 30 and 75 years, treatment with maximum effective doses of metformin and sulfonylurea for at least 3 months before screening, hemoglobin A1c levels in the range of 7–10% at screening, BMI between 25 kg/m2 and 45 kg/m2, and a history of stable body weight.

At week 26, hemoglobin A1c levels were reduced from baseline by 1.11% in both treatment groups, with a difference of 0.017 percentage points. Fasting plasma glucose levels were reduced in both treatment groups, but the reduction was significantly greater for patients who received insulin glargine. Exenatide reduced postprandial glucose excursions more effectively than did insulin glargine. Patients in the exenatide group experienced a reduction in mean body weight of 2.3 kg, whereas mean body weight increased by 1.8 kg in patients in the insulin glargine group. Overall rates of hypoglycemia were similar within both treatment groups. Gastrointestinal adverse events occurred more frequently in the exenatide group.

The authors conclude that exenatide and insulin glargine achieved similar improvements in glycemic control in patients with type 2 diabetes whose blood glucose levels were inadequately controlled with metformin and sulfonylurea therapy.