Is treatment with pioglitazone and exenatide more effective than insulin for poorly controlled type 2 diabetes?

This study compared a combination of pioglitazone (Actos) and exenatide (Byetta) to insulin therapy for poorly controlled type 2 diabetes (T2D). It found that more patients receiving pioglitazone and exenatide achieved blood glucose control compared to those receiving insulin.

Type 2 diabetes (T2D) occurs as a result of progressive loss of natural insulin production and increased resistance to insulin. One treatment option for poorly-controlled T2D is insulin therapy. However, this requires regular injections and can lead to episodes of low blood glucose and weight gain. Other options include exenatide which increases natural insulin production and pioglitazone which makes the body more sensitive to insulin. It is not known if these medications are as effective as insulin in T2D.

331 patients with poorly-controlled T2D participated in this study. Participants were already taking metformin (Glucophage) and a sulphonylurea drug. Participants were divided into two groups. Group 1 received pioglitazone and exenatide, group 2 received insulin injections. Participants were followed for an average of 32 months. Blood glucose control was measured through the HbA1c blood levels.

After 3 months, the HbA1c levels were 0.73% lower in group 1 compared to group 2. At the end of the study, this difference increased to 1.1%. 86% of group 1 and 44% of group 2 patients achieved an HbA1c lower than 7%. 

Group 1 patients also showed improved natural insulin secretion (2.5 times greater than the insulin group). Patients in both groups experienced weight gain. However, patients in group 2 gained significantly more weight compared to group 1 (9.6 kg vs 5.1).

This study showed that a combination of pioglitazone and exenatide is more effective at controlling blood glucose compared to insulin treatment in T2D. 

Thi study involved participants from one hospital in Qatar, further study is needed to see if these results also apply to other ethnicities. This study was partially supported by AstraZeneca, the manufacturer of exenatide.