title: Patient factors associated with glucagonlike peptide 1 receptor agonist use with and without insulin.
abstract: OBJECTIVE
  To evaluate both the patient factors associated with the initiation of exenatide and the real-world treatment patterns of exenatide use with and without insulin.
  
  
  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 was used to assess predictors of exenatide initiation and included adults with type 2 diabetes who were active in the database when exenatide became available (October 1, 2005). Cohort 2 was used to identify characteristics of patients who initiated exenatide with and without insulin.
  
  
  RESULTS
  Cohort 1 included 190 444 adults, and cohort 2 included 9810 adults. In cohort 1, 7383 patients initiated exenatide therapy; factors associated with exenatide initiation were female sex, younger age, body weight of 102.3 kg or greater, body mass index of 35 kg/m2 or greater, residence in the southern United States, a lower Charlson Comorbidity Index, previous or existing therapy with triple oral antidiabetic drugs, and insulin plus oral antidiabetic drugs. In cohort 2, 2470 exenatide-treated patients initiated exenatide with insulin (25%) (with or without oral antidiabetic drugs). They were more likely to weigh more than 113.6 kg, have a body mass index greater than 40 kg/m2, have a Charlson Comorbidity Index of 2 or greater, and have a baseline hemoglobin A1c level greater than 9%.
  
  
  CONCLUSIONS
  Exenatide concomitant with insulin use (with or without oral antidiabetic drugs) was common, and was 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.
authors.affiliation: University of Washington School of Medicine, Seattle, Washington, USA. ihirsch@u.washington.edu
authors.forename: Irl B
authors.initials: IB
authors.lastname: Hirsch
authors.forename: Yaping
authors.initials: Y
authors.lastname: Xu
authors.forename: Keith L
authors.initials: KL
authors.lastname: Davis
authors.forename: Brian
authors.initials: B
authors.lastname: Calingaert
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D000077270:Exenatide; D005260:Female; D000067757:Glucagon-Like Peptide-1 Receptor; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D018027:Receptors, Glucagon / Q000819:agonists*; D012189:Retrospective Studies; D014688:Venoms / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D000077270:Exenatide; D000067757:Glucagon-Like Peptide-1 Receptor; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D010455:Peptides; D018027:Receptors, Glucagon; D014688:Venoms; C000593833:GLP1R protein, human