Vandœuvre-lès-Nancy, France
Vandœuvre-lès-Nancy, France

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Kiiskinen U.,Eli Lilly and Company | Matthaei S.,Quakenbruck Diabetes Center | Reaney M.,Eli Lilly and Company | Mathieu C.,UZ Gasthuisberg | And 7 more authors.
ClinicoEconomics and Outcomes Research | Year: 2013

Purpose: CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy) assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study. Methods: CHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin) and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices. Results: A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P < 0.001 for both), but mean weight was reduced in the exenatide bid cohort (P < 0.001) and increased in the insulin cohort (P < 0.001) by 24 months. Across all countries, total per patient health care costs for the 24 months post baseline were €3997.9 in the exenatide bid cohort and €3265.5 in the insulin cohort (€1791.9 versus €2465.5 due to costs other than those of injectable therapy). When baseline direct cost and patients' and disease characteristics were controlled for, mean direct costs differed by country (P < 0.0001), irrespective of treatment initiated, and the mean cost difference between treatments varied by country (P < 0.0001). Conclusion: Much of the higher mean cost of exenatide bid, compared with insulin, therapy was compensated for by lower mean costs of other health service utilization. Costs associated with exenatide bid or insulin initiation varied across countries, highlighting the need to avoid generalization of resource use and cost implications of a particular therapy when estimated in specific country settings. © 2013 Kiiskinen etal, publisher and licensee Dove Medical Press Ltd.


PubMed | Metabolic Diseases and Nutrition, Aix - Marseille University and French Institute of Health and Medical Research
Type: Journal Article | Journal: Diabetes, obesity & metabolism | Year: 2016

To conduct a prospective randomized trial to investigate the effect of glucagon-like peptide-1 (GLP-1) analogues on ectopic fat stores.A total of 44 obese subjects with type 2 diabetes uncontrolled on oral antidiabetic drugs were randomly assigned to receive exenatide or reference treatment according to French guidelines. Epicardial adipose tissue (EAT), myocardial triglyceride content (MTGC), hepatic triglyceride content (HTGC) and pancreatic triglyceride content (PTGC) were assessed 45min after a standardized meal with 3T magnetic resonance imaging and proton magnetic resonance spectroscopy before and after 26weeks of treatment.The study population had a mean glycated haemoglobin (HbA1c) level of 7.50.2% and a mean body mass index of 36.11.1kg/m(2) . Ninety fivepercent had hepatic steatosis at baseline (HTGC5.6%). Exenatide and reference treatment led to a similar improvement in HbA1c (-0.70.3% vs. -0.70.4%; p=0.29), whereas significant weight loss was observed only in the exenatide group (-5.51.2kg vs. -0.20.8kg; p=0.001 for the difference between groups). Exenatide induced a significant reduction in EAT (-8.82.1%) and HTGC (-23.89.5%), compared with the reference treatment (EAT: -1.21.6%, p=0.003; HTGC: +12.59.6%, p=0.007). No significant difference was observed in other ectopic fat stores, PTGC or MTGC. In the group treated with exenatide, reductions in liver fat and EAT were not associated with homeostatic model assessment of insulin resistance index, adiponectin, HbA1c or fructosamin change, but were significantly related to weight loss (r=0.47, p=0.03, and r=0.50, p=0.018, respectively).Our data indicate that exenatide is an effective treatment to reduce liver fat content and epicardial fat in obese patients with type 2 diabetes, and these effects are mainly weight loss dependent.

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