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.


  1. Schernthaner G et al. Diabetes, Obesity and Metabolism. 2015; doi: 10.1111/dom.12471


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.