OBJECTIVE

Study the effects of exenatide (EXE) plus rosiglitazone (ROSI) on β-cell function and insulin sensitivity using hyperglycemic and euglycemic insulin clamp techniques in participants with type 2 diabetes on metformin.


RESEARCH DESIGN AND METHODS

In this 20-week, randomized, open-label, multicenter study, participants (mean age, 56 ± 10 years; weight, 93 ± 16 kg; A1C, 7.8 ± 0.7%) continued their metformin regimen and received either EXE 10 µg b.i.d. (n = 45), ROSI 4 mg b.i.d. (n = 45), or EXE 10 µg b.i.d. + ROSI 4 mg b.i.d. (n = 47). Seventy-three participants underwent clamp procedures to quantitate insulin secretion and insulin sensitivity.


RESULTS

A1C declined in all groups (P < 0.05), but decreased most with EXE+ROSI (EXE+ROSI, –1.3 ± 0.1%; ROSI, –1.0 ± 0.1%, EXE, –0.9 ± 0.1%; EXE+ROSI vs. EXE or ROSI, P < 0.05). ROSI resulted in weight gain, while EXE and EXE+ROSI resulted in weight loss (EXE, –2.8 ± 0.5 kg; EXE+ROSI, –1.2 ± 0.5 kg; ROSI, + 1.5 ± 0.5 kg; P < 0.05 between and within all groups). At week 20, 1st and 2nd phase insulin secretion was significantly higher in EXE and EXE+ROSI versus ROSI (both P < 0.05). Insulin sensitivity (M value) was significantly higher in EXE+ROSI versus EXE (P = 0.014).


CONCLUSIONS

Therapy with EXE+ROSI offset the weight gain observed with ROSI and elicited an additive effect on glycemic control with significant improvements in β-cell function and insulin sensitivity.

 

OBJECTIVE

Eliminating health disparities is a national priority, but progress has been difficult because of racial/ethnic differences in insurance coverage and access to health care. We investigated whether there were differences in diabetes care in the Veterans Administration (VA), where health care access should be relatively uniform.


RESEARCH DESIGN AND METHODS

A1C and plasma glucose were compared before/after diagnosis of diabetes.


RESULTS

Data were available for 1,456 black and 2,624 white veterans who met criteria for consistent primary care. Over 4–5 years before and after diagnosis, blacks had similar glucose and ~0.2% higher A1C levels than whites, and A1C differences could be attributed to glucose-independent associations between race and A1C. Blacks and whites also had comparable intervals between diagnostic-level hyperglycemia and diagnosis and between diagnosis and drug initiation. However, A1C was higher in blacks at the time of diagnosis (7.8 vs. 7.1%) and at initiation of pharmacotherapy (8.5 vs. 7.8%) (both P < 0.001). Differences in A1C at diagnosis and drug initiation were too large to be explained by differences in age, sex, BMI, and glucose-independent associations between race and A1C.


CONCLUSIONS

In the VA, glucose levels are generally comparable in blacks and whites except at the times of diagnosis and initiation of pharmacotherapy, when glucose levels are higher in blacks. While understanding the basis for such residual disparities may be important to improve the health of racial/ethnic minorities in the U.S., a health care system with structure and organization similar to that in the VA may also contribute importantly to relieving disparities in health.

 
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