title: Retrospective cohort study evaluating exenatide twice daily and long-acting insulin analogs in a Veterans Health Administration population with type 2 diabetes.
abstract: OBJECTIVE
  This was a retrospective cohort study that evaluated the differences in glycated haemoglobin (HbA1c) and body mass index (BMI) in veterans with type 2 diabetes mellitus (T2DM), prescribed exenatide twice daily (BID) versus long-acting insulin analog (LAIA) two years after initiation in the United States (US) veteran population.
  
  
  METHODS
  Patients were included if they were ≥ 18 years old with T2DM, and initiated exenatide BID or LAIA at the Veterans Health Administration between January 1, 2006 and December 31, 2010. Multivariate models were used to evaluate the changes in HbA1c and BMI between groups, controlling for potential confounders. Logistic regression was used to evaluate the odds of achieving ≥ 0.5% HbA1c reduction based on baseline HbA1c stratifications: low,<7%; moderate, 7% to<9%; and high,≥ 9%.
  
  
  RESULTS
  A total of 446 exenatide BID and 51,531 LAIA patients met inclusion/exclusion criteria. On average, exenatide BID patients were significantly older (64 versus 60 years) with a higher BMI (37.8 versus 32.9 kg/m(2)). Baseline HbA1c was 8.2% and 8.8% for exenatide BID and LAIA patients, respectively (P<0.001); otherwise, patients were similar for all other characteristics. Exenatide BID treatment was significantly associated with a 0.32% (95%CI: 0.18-0.47%) greater reduction in HbA1c at two years compared with LAIA. Similar findings were observed for BMI reduction (0.68 kg/m(2); 95%CI: 0.42-0.95 kg/m(2)). Exenatide BID patients with moderate baseline HbA1c had significantly higher odds of achieving ≥ 0.5% HbA1c reduction compared with LAIA patients (OR=1.5; 95%CI: 1.2-2.0).
  
  
  CONCLUSIONS
  Veterans treated with exenatide BID had significantly greater reduction in HbA1c and BMI compared with patients treated with LAIA patients two years after initiation.
authors: Veterans Affairs San Diego Healthcare System, San Diego, USA. Electronic address: mark.bounthavong@va.gov.
authors: M
authors: M
authors: Bounthavong
authors: Clinical Analytics and Outcomes Research, OptumRX, Irvine, CA, USA. Electronic address: josephine.tran@optum.com.
authors: J N
authors: JN
authors: Tran
authors: Advanced Center for Innovation in Services and Intervention Research (ACISIR), University of California, Department of Psychiatry, San Diego, CA, USA. Electronic address: sgolshan@ucsd.edu.
authors: S
authors: S
authors: Golshan
authors: Idaho State University, Institute of Rural Health, Pocatello, Idaho, USA. Electronic address: pilaneil@isu.edu.
authors: N F
authors: NF
authors: Piland
authors: UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California, USA. Electronic address: cmmorello@ucsd.edu.
authors: C M
authors: CM
authors: Morello
authors: Medical Relations & Information, Amylin Pharmaceuticals, LLC., a fully-owned subsidiary of Bristol-Myers Squibb, San Diego, California, USA. Electronic address: blickpharmd@hotmail.com.
authors: A
authors: A
authors: Blickensderfer
authors: Health Outcomes, Amylin Pharmaceuticals, LLC., a fully-owned subsidiary of Bristol-Myers Squibb, San Diego, California, USA; University of Washington, Seattle, Washington, USA. Electronic address: bestj@uw.edu.
authors: J H
authors: JH
authors: Best
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D000077270:Exenatide; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage*; D012189:Retrospective Studies; D014481:United States; D014688:Venoms / Q000008:administration & dosage*; D014728:Veterans; D058014:Veterans Health
chemical_list: D000077270:Exenatide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D010455:Peptides; D014688:Venoms
keywords: Detemir; Exenatide; Glargine; Long-acting insulin analogs; Pharmacoepidemiology; Retrospective cohort; Type 2 diabetes; Veterans