A real-life comparison of 3 non-insulin drugs for diabetes

The authors aimed to compare the effects of liraglutide (Victoza) to sitagliptin (Januvia) and exenatide (Byetta) in a real-life setting.

Glucagon-like peptide 1 (GLP-1) receptor agonists (liraglutide and exenatide) are drugs used in type 2 diabetes that increase insulin secretion to result in improved blood glucose control and reduced body weight.  Dipeptidyl peptidase 4 (DPP-4) inhibitors (sitagliptin) are drugs also used in type 2 diabetes prevent the breakdown of proteins important in balancing glucose levels in the body. While both are recommended for those who cannot achieve blood glucose control on metformin (Glucophage) alone, previous studies have confirmed the superior glucose-lowering effects of glucagon-like peptide 1 agonists.

This study aimed to evaluate the real-life effects of liraglutide compared to exenatide and sitagliptin in type 2 diabetes. The study evaluated the records from a health claims database of 234 patients who received liraglutide, 1,757 patients who received sitagliptin and 182 patients who received exenatide for a 6-month period. HbA1c levels (a measurement of average blood glucose levels over the past 3 months) were similar for all 3 groups at the beginning of the study at 7.9% for liraglutide, 7.9% for sitagliptin and 7.78% for exenatide.

After 6 months, those in the liraglutide group saw a 0.99% reduction in HbA1c levels compared to a 0.7% reduction for sitagliptin and 0.68% reduction for exenatide. 64.5% of those taking liraglutide achieved a HbA1c level of <7% compared to 49.2% of those taking sitagliptin and 54.4% of those taking exenatide. When the study took into account age, gender, initial HbA1c level, history of co-existing diseases and the use of other medications, liraglutide still resulted in greater reductions in HbA1c compared to sitagliptin and exenatide.

Compared to those taking liraglutide, those taking sitagliptin were 54.4% less likely to achieve a HbA1c level <7% at the 6-month follow-up, while those taking exenatide were 43.5% less likely to do so.

The authors concluded that patients who initiated and continued on liraglutide for 6 months achieved significantly greater reductions in HbA1c compared to sitagliptin and exenatide.

It was assumed that each claim from the health database was directly associated with a patient receiving and taking the medication; this was not directly measured.