Patient factors associated with glucagonlike peptide 1 receptor agonist use with and without insulin

Abstract

Objective: A conceptual advantage exists for use of exenatide with insulin for glycemic control and mitigation of hypoglycemia and weight gain associated with insulin. We evaluated real-world use of exenatide combined with insulin and patient factors associated with its use.
Methods: Using retrospective electronic medical records from the General Electric Centricity database, we performed analyses of 2 cohorts to separately evaluate factors associated with initiation of exenatide among patients with type 2 diabetes mellitus and differences between those who initiated exenatide with and without concurrent insulin use. Cohort 1 assessed predictors of exenatide initiation and included 190,444 adults with type 2 diabetes who were active in the database when exenatide became available (10/1/05). Cohort 2 identified characteristics of patients who initiated exenatide with and without insulin and consisted of 9,810 adults.
Results: In cohort 1, factors associated with initiation of exenatide (n=7,383) were female gender, younger age, weight ?225 lbs, BMI ?35 kg/m2, living in southern United States, a lower Charlson Comorbidity Index (CCI), prior/existing therapy with triple oral antidiabetic drugs (OADs), and insulin plus OADs. In cohort 2, 2,470 (25%) exenatide users initiated exenatide with insulin (± OADs). They were more likely to weigh >250 lbs with BMI >40 kg/m2, CCI ?2, and baseline HbA1c >9%.
Conclusions: Exenatide concomitant with insulin (± OADs) was common, and more likely to be prescribed in patients with morbid obesity, comorbid conditions, and poor glycemic control. Randomized controlled trials are needed to confirm the safe and effective use of this combination.