Evid Based Med doi:10.1136/eb-2013-101248
  • Therapeutics
  • Randomised controlled trial

Exenatide may improve maintenance of HbA1c targets, with less hypoglycaemia, but more early adverse effects when compared with low-dose glimepiride

  1. Jeffrey A Johnson2
  1. 1Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to: Dr Denise L Campbell-Scherer
    Department of Family Medicine, University of Alberta, 205 College Plaza, 8215 112 St NW, Edmonton, Alberta, Canada AB T6G 2C8; denise.campbell-scherer{at}

Commentary on: Gallwitz B, Guzman J, Dotta F, et al. Exenatide twice daily versus glimepiride for prevention of glycaemic deterioration in patients with type 2 diabetes with metformin failure (EUREXA): an open-label randomised controlled trial. Lancet 2012;379:2270–8.


Exenatide mimics the endogenous hormone glucagon-like peptide 1 (GLP-1).1 It affects glucose control by (1) suppressing glucagon secretion, (2) stimulating insulin release and (3) increasing satiety through delayed gastric emptying.1 Studies of GLP analogues find that they reduce glycated haemoglobin (HbA1c) by about 1%, but most have been short-term (26 weeks).1 They are associated with weight loss, and less hypoglycaemia compared with sulfonylureas.1 This EUREXA study is the longest study to date.


The EUREXA study was an allocation-concealed, randomised, open-label, non-inferiority trial of type 2 diabetic patients with HbA1c 6.5–9% on metformin, comparing …

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