HealthDay News — In patients with type 2 diabetes, treatment escalation options have different efficacy following failure of exenatide or glimepiride added to metformin, results of a study published in Diabetes, Obesity, and Metabolism suggest.
To assess third-line thiazolidinedione or glimepiride therapy in patients, Guntram Schernthaner, MD, of Rudolfstiftung Hospital in Vienna, and colleagues followed patients inadequately controlled on metformin + exenatide twice daily (n=144) and third-line exenatide twice daily (n=166). Changes in hemoglobin A1c (HbA1c), body mass index (BMI), lipids, hypoglycemia, and vital signs were monitored.
Add-on thiazolidinedione decreased HbA1c significantly better than add-on glimepiride among patients inadequately controlled on metformin + exenatide (130-week difference, 0.48%; P=0.001), but there were significant increases in BMI and systolic blood pressure. For add-on glimepiride to add-on thiazolidinedione, the ratio of documented systolic hypoglycemia rates was 8.48 (P<0.0001).
There was a significant reduction in HbA1c and BMI at 130 weeks with add-on exenatide after metformin + glimepiride, with an increased rate of documented symptomatic hypoglycemia from metformin + glimepiride (ratio, 1.49).
“Future studies should examine various other potential treatment combinations, doses, and sequences to help define optimal triple therapy,” concluded the investigators.
The study was funded by Amylin and Eli Lilly. Several authors and editors disclosed financial ties to these companies as well as Bristol-Myers Squibb and Astra Zeneca.