Observational study of kidney function and albuminuria in patients with type 2 diabetes treated with exenatide BID versus insulin glargine.

Background: Kidney disease is common among patients with type 2 diabetes (T2DM). Treatment of diabetes seeks to minimize negative kidney impact. Objective: To assess the changes in kidney function and incidence of albuminuria in patients with T2DM treated for 1 year with exenatide twice daily (BID) or insulin glargine. Methods: Retrospective analyses were performed using an electronic medical record database. Patients inititating treatment with either exenatide BID or insulin glargine between November 2006, and April 2009 comprised the study cohort. The 2 groups were 1:1 propensity score matched on baseline variables yielding 2683 pairs. Measures of kidney function included estimated glomerular filtration rate (eGFR,) and urinary albunnin/creatinine ratio (UACR). Results: Mean baseline eGFR was identical between the groups (79 +/- 23 mL/min/1.73 m(2)). At 1-year follow-up, there was no significant difference in mean eGFR between the groups (78 mL/min/1.73 m(2) for exenatide BID vs 80 mL/min/1.73 m(2) for insulin glargine; P = .39). Despite matching of multiple characteristics, mean baseline UACR was lower in the exenatide BID group (mean = 34 +/- 71 mg/g) compared with the insulin glargine group (183 +/- 509 mg/g; P = .03). At follow-up, exenatide BID patients had a mean increase in UACR of 104 mg/g, insulin glargine patients had a decrease of 47 mg/g, but the difference was not significant (P = .19). Conclusion: There were no significant differences in change in kidney function or albunninuria at 1 year in patients treated with exenatide BID compared with insulin glargine as administered in routine practice.