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Cited by 83Diabetes Treatment and ManagementDiabetes Management and ResearchPharmacology and Obesity Treatment

Once-Weekly Exenatide Versus Once- or Twice-Daily Insulin Detemir

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Davies, Melanie, Heller, Simon, Sreenan, Seamus, Sapin, Hélène, Adetunji, Omolara, Tahbaz, Arash, Vora, Jiten·2013·Diabetes Care
DOI 10.2337/dc12-1333PMC PMC3631870
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Abstract

OBJECTIVE: This multicenter, open-label, parallel-arm study compared the efficacy and safety of exenatide once weekly (EQW) with titrated insulin detemir in patients with type 2 diabetes inadequately controlled with metformin (with or without sulfonylureas). RESEARCH DESIGN AND METHODS: Patients were randomized to EQW (2 mg) or detemir (once or twice daily, titrated to achieve fasting plasma glucose ≤5.5 mmol/L) for 26 weeks. The primary outcome was proportion of patients achieving A1C ≤7.0% and weight loss ≥1.0 kg at end point, analyzed by means of logistic regression. Secondary outcomes included measures of glycemic control, cardiovascular risk factors, and safety and tolerability. RESULTS: Of 216 patients (intent-to-treat population), 111 received EQW and 105 received detemir. Overall, 44.1% (95% CI, 34.7-53.9) of EQW-treated patients compared with 11.4% (6.0-19.1) of detemir-treated patients achieved the primary outcome (P < 0.0001). Treatment with EQW resulted in significantly greater reductions than detemir in A1C (least-square mean ± SE, -1.30 ± 0.08% vs. -0.88 ± 0.08%; P < 0.0001) and weight (-2.7 ± 0.3 kg vs. +0.8 ± 0.4 kg; P < 0.0001). Gastrointestinal-related and injection site-related adverse events occurred more frequently with EQW than with detemir. There was no major hypoglycemia in either group. Five (6%) patients in the EQW group and six (7%) patients in the detemir group experienced minor hypoglycemia; only one event occurred without concomitant sulfonylureas (detemir group). CONCLUSIONS: Treatment with EQW resulted in a significantly greater proportion of patients achieving target A1C and weight loss than treatment with detemir, with a low risk of hypoglycemia. These results suggest that EQW is a viable alternative to insulin detemir treatment in patients with type 2 diabetes with inadequate glycemic control using oral antidiabetes drugs.

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  • GLP-1 RAs and dual GIP and GLP-1 RA in these trials had a lower risk of hypoglycemia compared with insulin.

    “GLP-1 RAs and dual GIP and GLP-1 RA in these trials also had a lower risk of hypoglycemia and beneficial effects on body weight compared with insulin, albeit with greater gastrointestinal side effects.”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [129]

    The Results (Safety and tolerability; page not provided) state that hypoglycemia incidence did not differ between once-weekly exenatide and insulin detemir. The Conclusions likewise report no difference in this trial and caution that the small number of events limits inference. (LLM, conf=0.90)

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  • In trials analyzing addition of injectable GLP-1 RA, dual GIP and GLP-1 RA, or insulin in people needing further glucose lowering, glycemic efficacies of GLP-1 RAs and the dual GIP and GLP-1 RA were similar to or greater than that of basal insulin.

    “In trials analyzing the addition of an injectable GLP-1 RA, dual GIP and GLP-1 RA, or insulin in people needing further glucose lowering, glycemic efficacies of GLP-1 RAs and the dual GIP and GLP-1 RA were similar to or greater than that of basal insulin (123-130).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [129]

    The Results (Secondary outcomes; page unavailable) report a significantly greater A1C reduction with once-weekly exenatide, a GLP-1 receptor agonist, than with basal insulin detemir in patients with type 2 diabetes inadequately controlled by oral drugs. This supports the GLP-1 RA comparison, but this trial did not evaluate a dual GIP/GLP-1 receptor agonist, so it cannot support that part of the sentence. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • GLP-1 RAs and dual GIP and GLP-1 RA in these trials had greater gastrointestinal side effects compared with insulin.

    “GLP-1 RAs and dual GIP and GLP-1 RA in these trials also had a lower risk of hypoglycemia and beneficial effects on body weight compared with insulin, albeit with greater gastrointestinal side effects.”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [129]

    The Results (Safety and tolerability; page unavailable) report more nausea, vomiting, and diarrhea with once-weekly exenatide than with insulin detemir. This supports the gastrointestinal-side-effect comparison for that GLP-1 receptor agonist, but the paper does not study a dual GIP/GLP-1 receptor agonist or establish the comparison across all the trials mentioned. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • GLP-1 RAs and dual GIP and GLP-1 RA in these trials had beneficial effects on body weight compared with insulin.

    “GLP-1 RAs and dual GIP and GLP-1 RA in these trials also had a lower risk of hypoglycemia and beneficial effects on body weight compared with insulin, albeit with greater gastrointestinal side effects.”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [129]

    The Results (Secondary outcomes) report that once-weekly exenatide reduced body weight while insulin detemir increased it, supporting the weight comparison for a GLP-1 receptor agonist. This trial does not study a dual GIP/GLP-1 receptor agonist, so it cannot support that part of the attributed claim. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 30

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Authors
Davies, M., Heller, S., Sreenan, S., Sapin, H., Adetunji, O., Tahbaz, A., & Vora, J.
Affiliations
  • University of Leicester (GB)
  • University of Sheffield (GB)
  • Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
  • Lilly France, Suresnes Cédex, France
  • Eli Lilly (United Kingdom) (GB)
  • Royal Liverpool University Hospital (GB)
Corresponding author
Davies, Melanie
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2013-04-13
Volume
36
Issue
5
Pages
1368-1376
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc12-1333
PMC
PMC3631870
OpenAlex
W2136546775
Cited by
83
References
7
Citations by year
2026: 2 · 2025: 7 · 2024: 2 · 2023: 6 · 2022: 1 · 2021: 2 · 2020: 7 · 2019: 4 · 2018: 7 · 2017: 9 · 2016: 12 · 2015: 13 · 2014: 6 · 2013: 2 · 2012: 2
FWCI
5.90
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Care (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
Keywords
exenatide once weekly, insulin detemir, type 2 diabetes, glycemic control, HbA1c, weight loss, hypoglycemia, gastrointestinal adverse effects, injection site reactions, metformin, sulfonylureas, inadequate glycemic control
MeSH terms
Insulin Detemir, Exenatide, Aged, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Male, Metformin, Middle Aged, Peptides, Sulfonylurea Compounds, Venoms, Treatment Outcome, Insulin, Long-Acting

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