Diabetes in Chinese Patients: Liraglutide vs. Exenatide

Glucagon-like peptide 1 (GLP-1) agonists are highly potent second-line agents for type 2 diabetes, protecting and improving beta-cell function and have a favorable adverse effect profile.

The CORE Diabetes Model (CDM) predicted the cost benefit of type 2 diabetics’ long-term clinical and economic outcomes in the US. CDM used a Markov Model to account for complications, clinical treatment, therapeutic outcomes, resource utilization, and direct medical costs, but it does not measure non-direct medical costs or pain and suffering.

A team of researchers from the Third Hospital of Hebei Medical University (in the People’s Republic of China) applied CDM to their population and found that liraglutide was cost-effective when given with metformin compared to exenatide.

In Chinese patients, type 2 diabetes tends to be related to failure of β-cell function more often than aggravated insulin resistance, which is a problem in Western populations.

The study followed hospitalized patients between November 2011 and March 2013 for 52 weeks who needed to meet the diabetes treatment and prevention guidelines diagnostic criteria, be 18 to 80 years old, have had inadequate response to metformin alone, and no history of GLP-1 agonist therapy.

The researchers excluded patients with severe cardiovascular or liver or kidney diseases, diabetic ketoacidosis history, an endocrine tumor or inflammatory disorder, or infectious or gastrointestinal diseases.

The researchers also compared liraglutide 1.2 mg to 1.8 mg daily to exenatide 5 mcg to 10 mcg twice daily. Liraglutide decreased the admitted patients HbA_lc by 1.1% after 52 weeks compared to exenatide’s 0.9% impact. Previous studies have shown a similar superiority over exenatide. Patients treated with liraglutide and exenatide lost weight, with average BMI reductions of 1.33% and 1.12%, respectively.

CDM predicted the liraglutide regimen to reduce direct and total medical costs by $320 and $672 more per year compared to the exenatide regimen. CDM also predicted the liraglutide regimen would add an additional 0.471 years to life expectancy.

Other studies have shown that liraglutide is cost-effective compared to glimepiride and sitagliptin.

The authors suggested that liraglutide may be preferred over exenatide in Chinese patients who have type 2 diabetes. They also note that these predictions are based on several assumptions, and the actual treatment environment in the future may differ.