Combination Therapy With Exenatide Plus Pioglitazone Versus Basal/Bolus Insulin in Patients With Poorly Controlled Type 2 Diabetes on Sulfonylurea Plus Metformin: The Qatar Study.

The Qatar Study was designed to examine the efficacy of combination therapy with exenatide plus pioglitazone versus basal/bolus insulin in patients with long-standing poorly controlled type 2 diabetes mellitus (T2DM) on metformin plus a sulfonylurea. The study randomized 231 patients with poorly controlled (HbA1c >7.5%, 58 mmol/mol) T2DM on a sulfonylurea plus metformin to receive 1) pioglitazone plus weekly exenatide (combination therapy) or 2) basal plus prandial insulin (insulin therapy) to maintain HbA1c <7.0% (53 mmol/mol). After a mean follow-up of 12 months, combination therapy caused a robust decrease in HbA1c from 10.0 ± 0.6% (86 ± 5.2 mmol/mol) at baseline to 6.1 ± 0.1% (43 ± 0.7 mmol/mol) compared with 7.1 ± 0.1% (54 ± 0.8 mmol/mol) in subjects receiving insulin therapy. Combination therapy was effective in lowering the HbA1c independent of sex, ethnicity, BMI, or baseline HbA1c. Subjects in the insulin therapy group experienced significantly greater weight gain and a threefold higher rate of hypoglycemia than patients in the combination therapy group. Combination exenatide/pioglitazone therapy is a very effective and safe therapeutic option in patients with long-standing poorly controlled T2DM on metformin plus a sulfonylurea.

卡塔尔研究旨在检验艾塞那肽联合吡格列酮与基础/餐时胰岛素在长期患有二甲双胍联合磺脲类药物控制不佳的2型糖尿病（T2DM）患者中的疗效。 该研究将231名服用磺脲类药物联合二甲双胍但控制不佳（糖化血红蛋白HbA1c>7.5%，即58 mmol/mol）的2型糖尿病患者随机分组，分别接受：1）吡格列酮联合每周一次的艾塞那肽（联合治疗）；2）基础胰岛素加餐时胰岛素（胰岛素治疗），以将糖化血红蛋白维持在<7.0%（53 mmol/mol）。 平均随访12个月后，联合治疗使糖化血红蛋白从基线时的10.0±0.6%（86±5.2 mmol/mol）大幅降低至6.1±0.1%（43±0.7 mmol/mol），而接受胰岛素治疗的受试者为7.1±0.1%（54±0.8 mmol/mol）。联合治疗在降低糖化血红蛋白方面是有效的，且不受性别、种族、体重指数（BMI）或基线糖化血红蛋白的影响。胰岛素治疗组的受试者体重增加明显更多，低血糖发生率是联合治疗组的三倍。 对于长期服用二甲双胍联合磺脲类药物控制不佳的2型糖尿病患者，艾塞那肽/吡格列酮联合治疗是一种非常有效且安全的治疗选择。