TY - JOUR
T1 - Combination therapy with pioglitazone/exenatide improves beta-cell function and produces superior glycaemic control compared with basal/bolus insulin in poorly controlled type 2 diabetes
T2 - A 3-year follow-up of the Qatar study
AU - Abdul-Ghani, Muhammad
AU - Migahid, Osama
AU - Megahed, Ayman
AU - DeFronzo, Ralph A.
AU - Al-Ozairi, Ebaa
AU - Jayyousi, Amin
N1 - Funding Information:
We would like to thank Evette Ibrahim, RN, and Huda Mejri, RN, for their excellent care of our patients, and Huda Esam, Mariam Al-Malahem and Kirollos Magdi for technical and logistic support throughout the study. The authors also thank the pharmacy team led by Dr Enas Abdoun, and the team of diabetes educators at Hamad General Hospital for dispensing the study medications, and for training patients on the use of insulin and Bydureon pens. This study was supported by Qatar Foundation grant NPRP 5-273-3-079. AstraZeneca provided the exenatide for the Qatar Study.
Funding Information:
This study was supported by Qatar Foundation grant NPRP 5‐273‐3‐079. AstraZeneca provided the exenatide for the Qatar study. Funding information
Publisher Copyright:
© 2020 John Wiley & Sons Ltd
PY - 2020/12
Y1 - 2020/12
N2 - Aim: To examine the long-term efficacy of thiazolidinedione plus a glucagon-like peptide-1 receptor agonist versus basal-bolus insulin on glycaemic control and beta-cell function in patients with poorly controlled type 2 diabetes (T2D) on metformin plus sulphonylurea. Materials and Methods: Three hundred and thirty-one patients with poorly controlled T2D were recruited over 3 years and were followed for an additional year. Subjects received a 75 g oral glucose tolerance test (OGTT) at baseline and at study end. After completing the baseline OGTT, subjects were randomized to receive either pioglitazone plus weekly exenatide (combination therapy) or basal/bolus insulin (insulin therapy) to maintain an HbA1c of less than 7.0%. The primary outcome of the study was the difference in HbA1c at study end between the two treatment groups. Results: Both therapies caused a robust decrease in HbA1c. However, combination therapy caused a greater decrement (−1.1%, P <.0001) than insulin therapy, and more subjects in the combination therapy group (86%) achieved the American Diabetes Association goal of glycaemic control (HbA1c < 7.0%) than those in the insulin therapy group (44%) (P <.0001). Both therapies improved insulin secretion. However, the improvement in insulin secretion with combination therapy was 2.5-fold greater (P <.001) than with insulin therapy (50%). Insulin therapy caused more weight gain and hypoglycaemia. Conclusion: Both combination therapy and insulin therapy effectively reduced HbA1c in poorly controlled T2D on multiple oral agents. However, combination therapy produced a greater improvement in insulin secretion and decrease in HbA1c with a lower risk of hypoglycaemia.
AB - Aim: To examine the long-term efficacy of thiazolidinedione plus a glucagon-like peptide-1 receptor agonist versus basal-bolus insulin on glycaemic control and beta-cell function in patients with poorly controlled type 2 diabetes (T2D) on metformin plus sulphonylurea. Materials and Methods: Three hundred and thirty-one patients with poorly controlled T2D were recruited over 3 years and were followed for an additional year. Subjects received a 75 g oral glucose tolerance test (OGTT) at baseline and at study end. After completing the baseline OGTT, subjects were randomized to receive either pioglitazone plus weekly exenatide (combination therapy) or basal/bolus insulin (insulin therapy) to maintain an HbA1c of less than 7.0%. The primary outcome of the study was the difference in HbA1c at study end between the two treatment groups. Results: Both therapies caused a robust decrease in HbA1c. However, combination therapy caused a greater decrement (−1.1%, P <.0001) than insulin therapy, and more subjects in the combination therapy group (86%) achieved the American Diabetes Association goal of glycaemic control (HbA1c < 7.0%) than those in the insulin therapy group (44%) (P <.0001). Both therapies improved insulin secretion. However, the improvement in insulin secretion with combination therapy was 2.5-fold greater (P <.001) than with insulin therapy (50%). Insulin therapy caused more weight gain and hypoglycaemia. Conclusion: Both combination therapy and insulin therapy effectively reduced HbA1c in poorly controlled T2D on multiple oral agents. However, combination therapy produced a greater improvement in insulin secretion and decrease in HbA1c with a lower risk of hypoglycaemia.
KW - exenatide, insulin, pioglitazone, Qatar study, type 2 diabetes
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UR - http://www.scopus.com/inward/citedby.url?scp=85090090355&partnerID=8YFLogxK
U2 - 10.1111/dom.14153
DO - 10.1111/dom.14153
M3 - Article
C2 - 32729222
AN - SCOPUS:85090090355
SN - 1462-8902
VL - 22
SP - 2287
EP - 2294
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
IS - 12
ER -