Department of Quantitative Health Sciences
Clinical Epidemiology | Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Epidemiology | Health Information Technology | Nutritional and Metabolic Diseases
INTRODUCTION: Analyses of efficacy and tolerability of pharmacologic interventions are based on clinical trials that often include predominately white populations, in part because of challenges associated with recruitment and retention of racial/ethnically diverse study populations. Using real-world electronic health record (EHR) data, we sought to evaluate the tolerability and effectiveness of exenatide once weekly (EQW), overall and relative to basal insulin (BI), according to race.
METHODS: Patients with type 2 diabetes initiating EQW or BI between 2012 and 2015 were selected from the Optum EHR Research Database, a system pooling data from dozens of hospitals throughout the US. Measures of HbA1c, weight, and body mass index (BMI) were summarized at initiation and quarterly in the first year afterwards. Occurrences of gastrointestinal (GI) symptoms and hypoglycemia were identified by diagnostic codes and clinical notes, and incidence rates (IR) and relative rates (RR) were calculated.
RESULTS: Overall, 4907 white patients (mean age = 57 years) and 454 African American patients (mean age = 53 years) were included. The percent change in HbA1c from initiation through 9-12 months was similar for white and African American patients [EQW-White: -6.89 (95% CI: -8.29, -5.50), EQW-African American: -5.99 (95% CI: -10.33, -1.65), BI-White: -4.68 (95% CI: -5.51, -3.86), BI-African American: -3.11 (95% CI: -5.37, -0.85)]. For EQW, percent change in weight was -1.73 (95% CI: -2.45, -1.02) for white patients and -1.11 (95% CI: -3.02, -0.81) for African American patients. No weight loss was observed among BI initiators. Relative to BI initiators, EQW initiators had lower rates of hypoglycemia [White RR: 0.82 (95% CI: 0.66, 1.01), African American RR: 0.59 (95% CI: 0.26, 1.34)]. GI symptoms were increased in white EQW initiators.
CONCLUSIONS: Treatment with EQW, relative to BI, was associated with larger reductions in HbA1c and weight and reduced risk of hypoglycemia, effects that were not different for white and African American patients.
FUNDING: AstraZeneca, Gothenburg, Sweden.
Basal insulin, Effectiveness, Electronic health record, Epidemiology, Exenatide, Tolerability
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© The Author(s) 2017. This article is an open access publication. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
DOI of Published Version
Diabetes Ther. 2017 Dec;8(6):1349-1364. doi: 10.1007/s13300-017-0314-z. Epub 2017 Oct 5. Link to article on publisher's site
Diabetes therapy : research, treatment and education of diabetes and related disorders
Nunes, Anthony P.; Loughlin, Anita M.; Qiao, Qing; Ezzy, Stephen M.; Yochum, Laura; Clifford, C Robin.; Gately, Robert V.; Dore, David D.; and Seeger, John D., "Tolerability and Effectiveness of Exenatide Once Weekly Relative to Basal Insulin Among Type 2 Diabetes Patients of Different Races in Routine Care" (2017). Open Access Articles. 3277.
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This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
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