Effects of exenatide twice daily versus sitagliptin on 24-h glucose, glucoregulatory and hormonal measures: a randomized, double-blind, crossover study Diabetes, Obesity and Metabolism, 10/12/2011

Berg JK et al. – Compared to sitagliptin, exenatide showed significantly lower average 24–h glucose, 2–h postprandial glucose (PPG), glucagon, caloric intake and improved homeostasis model assessment of β–cell function (HOMA–B).

• An 8–week, double–blind, randomized, crossover, single–centre study.
• Eighty–six subjects (58% female, body mass index 35 ± 5 kg/m², haemoglobin A1c 8.3 ± 1.0%) received either exenatide 10 μg (subcutaneous) twice daily or sitagliptin 100 mg (oral) daily for 4 weeks and crossed to the other therapy for an additional 4 weeks.
• Main outcome was time–averaged glucose during the 24–h inpatient visits.

• Both treatments decreased average 24–h glucose, but exenatide had a greater effect [between–group difference: –0.67 mmol/l, 95% confidence interval (CI): –0.9 to –0.4 mmol/l].
• Both treatments decreased 2–h postprandial glucose (PPG), area under the curve of glucose above 7.8 mmol/l (140 mg/dl) and 11 mmol/l (200 mg/dl) and increased the time spent with glucose between 3.9 and 7.8 mmol/l (70 and 140 mg/dl) during 24 h, but exenatide had a significantly greater effect (p < 0.05).
• Both treatments decreased postprandial serum glucagon, with exenatide having a greater effect (p < 0.005).
• Both treatments decreased fasting blood glucose to a similar degree (p = 0.766).
• Sitagliptin increased, while exenatide decreased, postprandial intact glucagon–like peptide–1.
• Both drugs improved homeostasis model assessment of β–cell function (HOMA–B), with exenatide having a significantly greater effect (p = 0.005).
• Both exenatide and sitagliptin decreased 24–h caloric intake, with exenatide having a greater effect (p < 0.001).
• There was no episode of major hypoglycaemia.
• Adverse events were mild to moderate and mostly gastrointestinal in nature with exenatide.
• No study withdrawals were due to an adverse event.