NEW YORK (Reuters Health) – In metformin-treated patients with type 2 diabetes, exenatide twice daily improves glycemic control to the same degree as insulin aspart twice daily, but with less hypoglycemia, researchers in Germany and Austria report.

Dr. Oliver Bachmann, with Lilly Deutschland in Bad Homburg, and colleagues conducted a study in 363 adults with type 2 diabetes to compare the frequency of hypoglycemia with exenatide versus insulin.

The subjects were all on metformin and were randomized to 26 weeks of treatment with exenatide b.i.d. (starting at 5 mcg, increasing to 10 mcg after 4 weeks) or premixed insulin aspart 70/30 b.i.d. The insulin dose was titrated to a fasting glucose level of 5.0-7.2 mmol/L and a 2h postprandial glucose of <10 mmol/L.

As reported in Diabetes Care online February 1, the mean change in A1C after 26 weeks was -1.0% with exenatide and -1.14% with insulin, a nonsignificant difference. A1C targets of <7.0% were achieved by 49.2% of exenatide patients and 56.6% of patients on insulin aspart.

Just 8% of patients on exenatide experienced at least one episode of hypoglycemia compared with 20.5% of those treated with insulin, the investigators found. Furthermore, weight changes were -4.1 kg in the exenatide group versus +1.0 kg in the insulin group.