Skip to main content
Top

05-10-2017 | GLP-1 agonists | Article

Tolerability and Effectiveness of Exenatide Once Weekly Relative to Basal Insulin Among Type 2 Diabetes Patients of Different Races in Routine Care

Journal: Diabetes Therapy

Authors: Anthony P. Nunes, Anita M. Loughlin, Qing Qiao, Stephen M. Ezzy, Laura Yochum, C. Robin Clifford, Robert V. Gately, David D. Dore, John D. Seeger

Publisher: Springer Healthcare

Abstract

Introduction

Analyses of efficacy and tolerability of pharmacologic interventions are based on clinical trials that often include predominately white populations, in part because of challenges associated with recruitment and retention of racial/ethnically diverse study populations. Using real-world electronic health record (EHR) data, we sought to evaluate the tolerability and effectiveness of exenatide once weekly (EQW), overall and relative to basal insulin (BI), according to race.

Methods

Patients with type 2 diabetes initiating EQW or BI between 2012 and 2015 were selected from the Optum EHR Research Database, a system pooling data from dozens of hospitals throughout the US. Measures of HbA1c, weight, and body mass index (BMI) were summarized at initiation and quarterly in the first year afterwards. Occurrences of gastrointestinal (GI) symptoms and hypoglycemia were identified by diagnostic codes and clinical notes, and incidence rates (IR) and relative rates (RR) were calculated.

Results

Overall, 4907 white patients (mean age = 57 years) and 454 African American patients (mean age = 53 years) were included. The percent change in HbA1c from initiation through 9–12 months was similar for white and African American patients [EQW-White: −6.89 (95% CI: −8.29, −5.50), EQW-African American: −5.99 (95% CI: −10.33, −1.65), BI-White: −4.68 (95% CI: −5.51, −3.86), BI-African American: −3.11 (95% CI: −5.37, −0.85)]. For EQW, percent change in weight was −1.73 (95% CI: −2.45, −1.02) for white patients and −1.11 (95% CI: −3.02, −0.81) for African American patients. No weight loss was observed among BI initiators. Relative to BI initiators, EQW initiators had lower rates of hypoglycemia [White RR: 0.82 (95% CI: 0.66, 1.01), African American RR: 0.59 (95% CI: 0.26, 1.34)]. GI symptoms were increased in white EQW initiators.

Conclusions

Treatment with EQW, relative to BI, was associated with larger reductions in HbA1c and weight and reduced risk of hypoglycemia, effects that were not different for white and African American patients.

Funding

AstraZeneca, Gothenburg, Sweden
Literature
1.
Cowie CC, Port FK, Wolfe RA, Savage PJ, Moll PP, Hawthorne VM. Disparities in incidence of diabetic end-stage renal disease according to race and type of diabetes. N Engl J Med. 1989;321:1074–9.CrossRefPubMed
2.
Harris MI, Klein R, Cowie CC, Rowland M, Byrd-Holt DD. Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A US population study. Diabetes Care. 1998;21:1230–5.CrossRefPubMed
3.
Lavery LA, Ashry HR, van Houtum W, Pugh JA, Harkless LB, Basu S. Variation in the incidence and proportion of diabetes-related amputations in minorities. Diabetes Care. 1996;19:48–52.CrossRefPubMed
4.
Pugh JA, Stern MP, Haffner SM, Eifler CW, Zapata M. Excess incidence of treatment of end-stage renal disease in Mexican Americans. Am J Epidemiol. 1988;127:135–44.CrossRefPubMed
5.
Kirk JK, D’Agostino RB Jr, Bell RA, Passmore LV, Bonds DE, Karter AJ, Narayan KM. Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care. 2006;29:2130–6.CrossRefPubMedPubMedCentral
6.
Auslander WF, Thompson S, Dreitzer D, White NH, Santiago JV. Disparity in glycemic control and adherence between African–American and Caucasian youths with diabetes. Family and community contexts. Diabetes Care. 1997;20:1569–75.CrossRefPubMed
7.
Brown SD, Lee K, Schoffman DE, King AC, Crawley LM, Kiernan M. Minority recruitment into clinical trials: experimental findings and practical implications. Contemp Clin Trials. 2012;33:620–3.CrossRefPubMedPubMedCentral
8.
Otado J, Kwagyan J, Edwards D, Ukaegbu A, Rockcliffe F, Osafo N. Culturally competent strategies for recruitment and retention of African American populations into clinical trials. Clin Transl Sci. 2015;8:460–6.CrossRefPubMedPubMedCentral
9.
Davidson JA, Lacaya LB, Jiang H, Heilmann CR, Scism-Bacon JL, Gates JR, Jackson JA. Impact of race/ethnicity on the efficacy and safety of commonly used insulin regimens: a post hoc analysis of clinical trials in type 2 diabetes mellitus. Endocrine Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2010;16:818–28.
10.
Ghazi A, Landerman LR, Lien LF, Colon-Emeric CS. Impact of race on incidence of hypoglycemia in hospitalized older adults with type 2 diabetes. Clin Diabetes. 2013;31:66–72.CrossRef
11.
Seeger JD, Kurth T, Walker AM. Use of propensity score technique to account for exposure-related covariates: an example and lesson. Med Care. 2007;45:S143–8.CrossRefPubMed
12.
Seeger JD, Williams PL, Walker AM. An application of propensity score matching using claims data. Pharmacoepidemiol Drug Saf. 2005;14:465–76.CrossRefPubMed
13.
Lee KJ, Carlin JB. Multiple imputation for missing data: fully conditional specification versus multivariate normal imputation. Am J Epidemiol. 2010;171:624–32.CrossRefPubMed
14.
Valente MA, Hillege HL, Navis G, Voors AA, Dunselman PH, van Veldhuisen DJ, Damman K. The chronic kidney disease epidemiology collaboration equation outperforms the modification of diet in renal disease equation for estimating glomerular filtration rate in chronic systolic heart failure. Eur J Heart Fail. 2014;16:86–94.CrossRefPubMed
15.
Nunes AP, Yang J, Tunceli K, Kurtyka K, Radican L, Engel SS, Yu S, Doherty MC, Dore DD. Interim results on the relationship between mild-moderate and severe hypoglycemia and cardiovascular disease in a cohort of sulfonylurea users. In: 51st European Association for the Study of Diabetes. Stockholm, Sweden.
16.
Nunes AP, Yu S, Kurtyka K, Senerchia C, Hill J, Brodovicz KG, Radican L, Engel SS, S.R. C, Dore DD. Natural language processing of clinical notes in electronic health records to improve capture of hypoglycemia. In: 30th International Conference of Pharmacoepidemiology. Taipei.
18.
Reducing bias in a propensity score matched-pair sample using greedy matching techniques. In SAS SUGI 26, Paper 214-26 [article online], 2001. Available from http://​www2.​sas.​com/​proceedings/​sugi26/​p214-26.​pdf Accessed 30 Sept 2014.
19.
Ginde AA, Blanc PG, Lieberman RM, Camargo CA Jr. Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visits. BMC Endocr Disord. 2008;8:4.CrossRefPubMedPubMedCentral
20.
Diamant M, Van Gaal L, Stranks S, Guerci B, MacConell L, Haber H, Scism-Bacon J, Trautmann M. Safety and efficacy of once-weekly exenatide compared with insulin glargine titrated to target in patients with type 2 diabetes over 84 weeks. Diabetes Care. 2012;35:683–9.CrossRefPubMedPubMedCentral

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »