Treatment outcomes after initiation of exenatide twice daily or insulin in clinical practice: 12-month results from CHOICE in six European countries

Abstract

Objective:The CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy (CHOICE) study assessed time to, and reasons for, significant treatment change after patients with type 2 diabetes (T2DM) initiated their first injectable glucose-lowering therapy (exenatide twice daily [BID] or insulin) in routine clinical practice, and these patients’ clinical outcomes, in six European countries. This paper reports interim data from the first 12 months of the study.Research design and methods:CHOICE (NCT00635492) is a prospective, noninterventional, observational study. Clinical data were collected at initiation of first injectable therapy and after approximately 3, 6, and 12 months.Results:Of 2497 patients enrolled in CHOICE, 1096 in the exenatide BID and 1239 in the insulin cohorts had ≥1 post-baseline assessment and were included in this analysis. Overall, 32.2% of the exenatide BID cohort and 29.1% of the insulin cohort (Kaplan–Meier estimates) had significant treatment change during the first 12 months, most commonly discontinuing injectable therapy or adding new T2DM therapy, respectively. Glycemic control improved in both cohorts, but weight loss occurred only in the exenatide BID cohort (mean change −3.3 kg). Hypoglycemia occurred in 13.2% of the exenatide BID cohort and 28.6% of the insulin cohort (82.8% and 55.6% of these patients, respectively, received sulfonylureas). The post hoc endpoint of glycated hemoglobin < 7%, no weight gain, and no hypoglycemia was attained at 12 months by 24.3% and 10.3% of patients who had data at 12 months and who were receiving exenatide BID and insulin, respectively.Conclusion:About 30% of patients in CHOICE changed treatment in the first 12 months after initiation of first injectable therapy (exenatide BID or insulin). Overall, both cohorts achieved improved glycemic control, which was accompanied by a mean weight loss in the exenatide BID cohort.

Non-Persistence and Non-Adherence of Patients with Type 2 Diabetes Mellitus in Therapy with GLP-1 Receptor Agonists: A Retrospective Analysis

“…It reported a higher unadjusted MPR for once-weekly therapy (78.3%), compared to BID (50.0%) or OD therapy (68.3–76.1% depending on dosage) [23]. The only known European-based study which analyzed adherence/persistence to therapy with GLP-1 receptor agonists reported a 12-month therapy discontinuation rate of 32.2% to BID treatment [27]. So, generally, our numbers indicate a slightly higher persistence/adherence than shown in previous studies.…”

“…Much less is known about the level of persistence/adherence to therapy with GLP-1 receptor agonists. Three previous US analyses reported 12-month medication possession ratios (MPRs) of 68% for BID GLP-1 [21], 69.7% for OD GLP-1 and 64.4% for BID GLP-1 [22], or 78.3% for once-weekly GLP-1, compared to 50.0% for BID GLP-1 and 68.3–76.1% for OD GLP-1 [23], the only known European-based study reported a 12-month therapy discontinuation rate of 32.2% for BID therapy with GLP-1 receptor agonists only [24]. Consequently, there is limited real-world data from European T2DM patients about the persistence and adherence to therapy with GLP-1 receptor agonists.…”

Beneficial Effects of Evogliptin, a Novel Dipeptidyl Peptidase 4 Inhibitor, on Adiposity with Increased Ppargc1a in White Adipose Tissue in Obese Mice

“…GLP-1 receptors also exist on the surface of adipose tissue and their activation can cause adipogenesis [ 11 ] but enhance lipolysis [ 12 ]. GLP-1 analogues have shown to reduce body weight by restricting caloric intake [ 13 – 15 ]. In contrast to GLP-1 analogues and genetic deficiency of DPP4 [ 16 ], DPP4 inhibitors do not affect food consumption [ 8 , 17 ], suggesting its effects in energy homeostasis may be governed by different mechanisms of action.…”

Observational Study of Patients in Morocco With Uncontrolled Type 2 Diabetes Treated With Metformin and/or Sulfonylurea With or Without Insulin

“…These authors explained this by a lack of resources and educational efforts regarding diet and weight. In the CHOICE study carried out over 12 months in six European countries and looking at changes to treatment and outcomes, the percentage of patients in the insulin cohort with HbA1c < 7% increased from 5.1% at baseline to 32.2% [29]. In a metaanalysis, evaluating the benefits of initiating insulin glargine following the failure of metformin/sulfonylurea mono-or combined therapy, 68.1%, 50.4% and 56.4% achieved HbA1c ≤ 7.0%, respectively [30].…”

“…In a recent real-world study from the USA, an electronic medical record database for adult patients with T2DM showed that during follow-up (> 1 year), patients initiating insulin glargine had a greater change in HbA1c (-1.1%) [31]. In the CHOICE study, glycemic control was improved in patients starting insulin by a mean absolute reduction in HbA1c of -1.8% (±1.8) [29]. The decrease in HbA1c levels in our study during followup suggests that many of our patients may have received diabetic education and optimum management.…”