exenatide and Renal-Insufficiency

To evaluate the effectiveness and tolerability of exenatide once weekly (EQW) compared with basal insulin (BI) among injectable-drug-naïve patients with type 2 diabetes mellitus (T2DM) who are elderly or have renal impairment (RI).. Initiators of EQW and BI with T2DM were identified for the period 2012 to 2015 within a US electronic health record database and matched by propensity score. Matched EQW and BI initiators aged ≥65 years or who had RI were compared. Data on weight, glycated haemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), blood pressure and lipids were obtained at baseline and quarterly (Q1-Q4) or semi-annually for 1 year after drug initiation. Hypoglycaemia and gastrointestinal symptoms were identified using diagnosis codes and data abstracted from clinical notes.. Among patients aged ≥65 years, HbA1c changed by -0.50 and -0.31 percentage points from baseline to Q4 for EQW and BI initiators, respectively. Weight changed by -1.6 kg among EQW initiators compared with 0.2 kg among BI initiators. Compared with BI initiators, EQW initiators had a 1.45-fold increased risk of nausea and vomiting. Among patients with RI, HbA1c changed by -0.58 and -0.33 percentage points from baseline to Q4 for EQW and BI initiators, respectively. Weight changed by -1.9 kg for EQW initiators while BI initiators had no change in weight. EQW initiators had a 1.28-fold increased risk of constipation and diarrhoea compared with BI initiators.. Regardless of age or renal function, the benefits of EQW relative to BI treatment are improved glycaemic control and increased weight loss, which should be weighed against the increased risk of gastrointestinal symptoms.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blood Glucose; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Drug Administration Schedule; Exenatide; Female; Follow-Up Studies; Humans; Injections, Subcutaneous; Insulin; Male; Middle Aged; Renal Insufficiency; Retrospective Studies; Treatment Outcome; United States; Young Adult

Topics: Diabetes Mellitus, Type 2; Exenatide; Female; Humans; Hypoglycemic Agents; Middle Aged; Peptides; Renal Insufficiency; Risk Factors; Venoms

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Creatinine; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Diuretics; Exenatide; Female; Humans; Hypoglycemic Agents; Ischemia; Kidney Glomerulus; Male; Middle Aged; Peptides; Renal Insufficiency; Venoms

Topics: Cost-Benefit Analysis; Europe; Exenatide; Humans; Hypoglycemic Agents; Peptides; Renal Insufficiency; Venoms