BACKGROUND: Diabetes is associated with a higher risk for adverse cardiovascular 
outcomes. To improve the health outcomes of patients with type 2 diabetes 
(T2DM), the American Diabetes Association (ADA) recommended target goals for the 
improvement of glycemic control and the reduction of cardiovascular risk factors 
associated with the disease. This retrospective analysis calculated the absolute 
benefit increase (ABI) of using exenatide once weekly (QW), a glucagon-like 
peptide-1 (GLP-1) receptor agonist, vs an oral glucose-lowering medication or 
insulin glargine to achieve ADA-recommended goals. The number needed to treat 
(NNT) to achieve these goals was also calculated and provides a useful clinical 
metric for comparing potential therapies from different drug classes.
METHODS: Patient data from three double-blind or open label, 26-week, 
randomized, controlled trials were retrospectively analyzed separately. ABI and 
NNT were calculated by comparing the percentage of patients treated with 
exenatide QW (N = 641) vs metformin (N = 246), sitagliptin (N = 329), 
pioglitazone (N = 328), or insulin glargine (N = 223), who achieved a single 
glycemic, weight, blood pressure, or lipid goal or a composite of these 
recommended goals, during the DURATION-2, -3, and -4 clinical trials.
RESULTS: Significant ABIs favoring exenatide QW over all four glucose-lowering 
medications were observed for at least one HbA1c glycemic goal. NNTs of 4 and 5 
were calculated when exenatide QW was compared to sitagliptin for attaining 
HbA1c goals of <7.0% and ≤6.5%, respectively. Additionally, significantly more 
patients using exenatide QW compared to sitagliptin, pioglitazone, or insulin 
glargine attained the composite goal of HbA1c <7% or ≤6.5%, without weight gain 
or hypoglycemia. Exenatide QW was also favored over sitagliptin and insulin 
glargine for the achievement of the composite goals of HbA1c <7% (or ≤6.5%), 
systolic blood pressure <130 mm Hg, and low-density lipoprotein <2.59 mmol/L. 
For most goals, exenatide QW and metformin had similar effects in treatment 
naïve patients.
CONCLUSIONS: This analysis assessed the between-therapy differences in achieving 
therapeutic goals with therapies commonly used for glycemic control in patients 
with T2DM. In clinical trials, exenatide QW assisted more patients in reaching 
the majority of ADA-recommended therapeutic goals than treatment with 
sitagliptin, pioglitazone, or insulin glargine.
TRIAL REGISTRATION: NCT00637273, NCT00641056, NCT00676338.