Patient-reported outcomes in trials of incretin-based therapies in patients with type 2 diabetes mellitus

Diabetes Obes Metab. 2012 Oct;14(10):882-92. doi: 10.1111/j.1463-1326.2012.01595.x. Epub 2012 Apr 17.

Abstract

Incretin-based therapies have a glucose-dependent mode of action that results in excellent glucose-lowering efficacy with very low risk of hypoglycaemia, and weight neutrality [dipeptidyl peptidase-4 (DPP-4) inhibitors] or weight loss [glucagon-like peptide-1 (GLP-1) receptor agonists], in people with type 2 diabetes mellitus (T2DM). Patient-reported outcomes (PROs) complement physician evaluations of efficacy and tolerability and offer insights into the subjective experience of using modern diabetes treatments. We conducted a systematic search of clinical trials of the GLP-1 receptor agonists liraglutide, exenatide and long-acting exenatide, one of which included the oral DPP-4 inhibitor sitagliptin as a comparator. No other PRO data for DPP-4 inhibitors were identified. This review summarizes PRO data from eight clinical trials, the majority of which used the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and/or Impact of Weight on Quality of Life-Lite (IWQOL-Lite) to evaluate patient experience. People with T2DM were highly satisfied with modern incretin-based therapies compared with traditional therapies. Treatment satisfaction (including perceptions of convenience and flexibility) was high and generally higher with GLP-1 agonists in association with their greater glucose-lowering efficacy and tendency to facilitate weight loss. Weight-related quality of life (QoL) also improved in people using incretin therapies. The glycaemic improvements achieved with GLP-1 receptor agonists, coupled with the low incidence of hypoglycaemia and ability to cause weight loss, seemed to offset potential concern about injections. It is plausible that superior patient-reported benefits found in clinical trials may translate into improved, clinically meaningful, long-term outcomes through increased treatment acceptability. Long-term, prospective data are needed to ascertain whether this is the case in practice.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Clinical Trials as Topic
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Dipeptidyl-Peptidase IV Inhibitors / administration & dosage*
  • Dipeptidyl-Peptidase IV Inhibitors / pharmacology*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Exenatide
  • Female
  • Glucagon-Like Peptide 1 / administration & dosage
  • Glucagon-Like Peptide 1 / analogs & derivatives
  • Glucagon-Like Peptide 1 / pharmacology
  • Glycated Hemoglobin A / drug effects
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / drug therapy*
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / pharmacology*
  • Incretins / metabolism*
  • Injections, Subcutaneous
  • Liraglutide
  • Male
  • Medication Adherence / statistics & numerical data
  • Patient Satisfaction
  • Peptides / administration & dosage
  • Peptides / pharmacology
  • Pyrazines / administration & dosage
  • Pyrazines / pharmacology
  • Self Care
  • Sitagliptin Phosphate
  • Surveys and Questionnaires
  • Treatment Outcome
  • Triazoles / administration & dosage
  • Triazoles / pharmacology
  • Venoms / administration & dosage
  • Venoms / pharmacology
  • Weight Loss / drug effects*

Substances

  • Dipeptidyl-Peptidase IV Inhibitors
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Incretins
  • Peptides
  • Pyrazines
  • Triazoles
  • Venoms
  • hemoglobin A1c protein, human
  • Liraglutide
  • Glucagon-Like Peptide 1
  • Exenatide
  • Sitagliptin Phosphate