All you need to read in the other general journalsBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4055 (Published 13 June 2012) Cite this as: BMJ 2012;344:e4055
Exenatide tops glimepiride as add on to metformin
It is not clear which drugs are best added to treatment of type 2 diabetes that is poorly controlled by lifestyle measures and metformin alone. Exenatide—a glucagon-like peptide 1 (GLP-1) receptor agonist—showed advantages over the sulphonylurea glimepiride in a manufacturer sponsored open label trial that spanned 128 centres in 14 countries over four and a half years.
Of the 490 patients randomised to exanatide included in the analysis, 41% (203) needed alternative treatment because of inadequate serum glucose control over the three years of the trial. With glimepiride, 54% (262/487) needed alternative treatment. Concentrations of less than 7% glycated haemoglobin were achieved in 44% (218) of people taking exenatide compared with 31% (150) for glimepiride. Exenatide induced an average weight loss of 3.32 kg, whereas people taking glimepiride gained 1.15 kg on average. As expected, hypoglycaemia was less common with exenatide; unlike sulphonylureas, insulin secretion with GLP-1 receptor agonists depends on serum glucose concentrations.
Glimepiride was better tolerated though—only 17 participants stopped taking the drug because of adverse events compared with 49 people taking exenatide. The difference was significant only for the first six months after treatment onset. The most common adverse event was nausea (29% (147) for exenatide v 2% (11) for glimepiride). Five people died in both groups for reasons judged not to be related to diabetes, and one participant in each group had pancreatitis.
We will have to wait until 2015 to see trial quality cardiovascular outcomes related to GLP-1 receptor agonists, says a linked comment (doi:10.1016/S0140-6736(12)60769-7).
Low dose aspirin increases risk of major bleeding, but not in people with diabetes
Low dose aspirin for primary prevention of cardiovascular events is generally considered a bad idea because the risks of bleeding seem to outweigh the benefits. However, things may be different for people with diabetes⇑. …