Treatment outcomes after initiation of exenatide twice daily or insulin in clinical practice: 12-month results from CHOICE in six European countries

Claes-Göran Östenson,¹ Stephan Matthaei,² Matthew Reaney,³ Thure Krarup,⁴ Bruno Guerci,⁵ Jacek Kiljanski,⁶ Carole Salaun-Martin,⁷ Hélène Sapin,⁷ David Bruhn,⁸ Chantal Mathieu,⁹ Michael Theodorakis<sup>10

1</sup>Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; ²Diabetes-Center Quakenbrück, Quakenbrück, Germany; ³Eli Lilly, Windlesham, Surrey, UK; ⁴Department of Endocrinology I, Bispebjerg Hospital, Copenhagen, Denmark; ⁵Diabetology, Metabolic Diseases and Nutrition, Brabois Hospital, CHU Nancy, and INSERM CIC, ILCV, Vandoeuvre Lès Nancy, France; ⁶Eli Lilly, Warsaw, Poland; ⁷Eli Lilly, Neuilly Cedex, France; ⁸Eli Lilly, San Diego, California, USA; ⁹Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium; ¹⁰Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece*

*Michael Theodorakis was affiliated with the institution shown at the time of the study, but has since left this institution

Objective: The CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy (CHOICE) study assessed time to, and reasons for, significant treatment change after patients with type 2 diabetes (T2DM) initiated their first injectable glucose-lowering therapy (exenatide twice daily [BID] or insulin) in routine clinical practice, and these patients’ clinical outcomes, in six European countries. This paper reports interim data from the first 12 months of the study.
Research design and methods: CHOICE (NCT00635492) is a prospective, noninterventional, observational study. Clinical data were collected at initiation of first injectable therapy and after approximately 3, 6, and 12 months.
Results: Of 2497 patients enrolled in CHOICE, 1096 in the exenatide BID and 1239 in the insulin cohorts had ≥1 post-baseline assessment and were included in this analysis. Overall, 32.2% of the exenatide BID cohort and 29.1% of the insulin cohort (Kaplan–Meier estimates) had significant treatment change during the first 12 months, most commonly discontinuing injectable therapy or adding new T2DM therapy, respectively. Glycemic control improved in both cohorts, but weight loss occurred only in the exenatide BID cohort (mean change –3.3 kg). Hypoglycemia occurred in 13.2% of the exenatide BID cohort and 28.6% of the insulin cohort (82.8% and 55.6% of these patients, respectively, received sulfonylureas). The post hoc endpoint of glycated hemoglobin < 7%, no weight gain, and no hypoglycemia was attained at 12 months by 24.3% and 10.3% of patients who had data at 12 months and who were receiving exenatide BID and insulin, respectively.
Conclusion: About 30% of patients in CHOICE changed treatment in the first 12 months after initiation of first injectable therapy (exenatide BID or insulin). Overall, both cohorts achieved improved glycemic control, which was accompanied by a mean weight loss in the exenatide BID cohort.

Keywords: type 2 diabetes mellitus, exenatide, insulin, injectable therapy