THE EFFECT OF EXENATIDE THERAPY IN PREVIOUSLY INSULIN-TREATED TYPE 2 DIABETIC PATIENTS

Overview

Journal Acta Endocrinol (Buchar)

Specialty Endocrinology

Date 2019 Jun 1

PMID 31149215

Authors

H Y Yasar

B Ozturk Ceyhan

B O Pamuk

M Demirpence

O Ertugrul

D Ertugrul

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the effect of multiple daily injection (MDI) treatment replaced by Exenatide BID as compared with continuation of MDI.

Patients And Methods: A total of 140 patients with type 2 diabetes, taking metformin and multiple daily insulin injections, were randomized to exenatide or insulin group that continued their insulin treatment. Patients were followed-up for 16 weeks. Blood glucose profiles, BMI, waist circumference, HbA1C, serum lipids and side effects were assesssed at weeks 0,12 and 16.

Results: There were no significant differences between the two groups with respect to baseline parameters. Glycemic control was similar between the two groups. The mean changes in HbA1C in exenatide group were -0.66±0.63% and in insulin group -0.74±0.92 % (p=0.594). In exenatide group, 59.6 % of patients and in insulin group 85.71 % of patients had maintained or improved glycemic control at the end of the study. In insulin group, insulin requirement increased 5.86 ± 4.46 units/day. Body weight and waist circumference decreased significantly in exenatide treatment group with respect to insulin group (p<0.001).

Conclusions: Substituting exenatide for insulin might be an option in insulin-treated, type 2 diabetic patients having obesity, and poor glycemic control. However, patients with longer duration of diabetes and insulin treatment and with lower C-peptide levels might not benefit from exenatide therapy.

References

Barthelemy M, Boullu Sanchis S, Moreau F, Reix N, Pinget M, Sigrist S . Substitution of insulin by exenatide in bad controlled type 2 diabetic patients: efficacy and predictive factors. Minerva Endocrinol. 2014; 40(3):155-61. View

Rosenstock J, Shenouda S, Bergenstal R, Buse J, Glass L, Heilmann C . Baseline factors associated with glycemic control and weight loss when exenatide twice daily is added to optimized insulin glargine in patients with type 2 diabetes. Diabetes Care. 2012; 35(5):955-8. PMC: 3329851. DOI: 10.2337/dc11-1434. View

Nauck M, Duran S, Kim D, Johns D, Northrup J, Festa A . A comparison of twice-daily exenatide and biphasic insulin aspart in patients with type 2 diabetes who were suboptimally controlled with sulfonylurea and metformin: a non-inferiority study. Diabetologia. 2006; 50(2):259-67. DOI: 10.1007/s00125-006-0510-2. View

Bergenstal R, Lewin A, Bailey T, Chang D, Gylvin T, Roberts V . Efficacy and safety of biphasic insulin aspart 70/30 versus exenatide in subjects with type 2 diabetes failing to achieve glycemic control with metformin and a sulfonylurea. Curr Med Res Opin. 2009; 25(1):65-75. DOI: 10.1185/03007990802597951. View

Perfetti R . Combining basal insulin analogs with glucagon-like peptide-1 mimetics. Diabetes Technol Ther. 2011; 13(9):873-81. PMC: 3160265. DOI: 10.1089/dia.2010.0250. View

Horton E, Silberman C, Davis K, Berria R . Weight loss, glycemic control, and changes in cardiovascular biomarkers in patients with type 2 diabetes receiving incretin therapies or insulin in a large cohort database. Diabetes Care. 2010; 33(8):1759-65. PMC: 2909058. DOI: 10.2337/dc09-2062. View

Bunck M, Diamant M, Corner A, Eliasson B, Malloy J, Shaginian R . One-year treatment with exenatide improves beta-cell function, compared with insulin glargine, in metformin-treated type 2 diabetic patients: a randomized, controlled trial. Diabetes Care. 2009; 32(5):762-8. PMC: 2671094. DOI: 10.2337/dc08-1797. View

Davis S, Johns D, Maggs D, Xu H, Northrup J, Brodows R . Exploring the substitution of exenatide for insulin in patients with type 2 diabetes treated with insulin in combination with oral antidiabetes agents. Diabetes Care. 2007; 30(11):2767-72. DOI: 10.2337/dc06-2532. View

Buse J, Rosenstock J, Sesti G, Schmidt W, Montanya E, Brett J . Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6). Lancet. 2009; 374(9683):39-47. DOI: 10.1016/S0140-6736(09)60659-0. View

10.

Kaimal N, Schofield J, Zaki A, Patel R, Sharma M, McCourt E . Effects of exenatide in poorly controlled type 2 diabetes. QJM. 2011; 105(4):321-6. DOI: 10.1093/qjmed/hcr180. View

11.

Gallwitz B, Bohmer M, Segiet T, Molle A, Milek K, Becker B . Exenatide twice daily versus premixed insulin aspart 70/30 in metformin-treated patients with type 2 diabetes: a randomized 26-week study on glycemic control and hypoglycemia. Diabetes Care. 2011; 34(3):604-6. PMC: 3041190. DOI: 10.2337/dc10-1900. View

12.

Nayak U, Govindan J, Baskar V, Kalupahana D, Singh B . Exenatide therapy in insulin-treated type 2 diabetes and obesity. QJM. 2010; 103(9):687-94. DOI: 10.1093/qjmed/hcq112. View

13.

Shyangdan D, Royle P, Clar C, Sharma P, Waugh N . Glucagon-like peptide analogues for type 2 diabetes mellitus: systematic review and meta-analysis. BMC Endocr Disord. 2010; 10:20. PMC: 3017518. DOI: 10.1186/1472-6823-10-20. View

14.

Arnolds S, Dellweg S, Clair J, Dain M, Nauck M, Rave K . Further improvement in postprandial glucose control with addition of exenatide or sitagliptin to combination therapy with insulin glargine and metformin: a proof-of-concept study. Diabetes Care. 2010; 33(7):1509-15. PMC: 2890351. DOI: 10.2337/dc09-2191. View

15.

Barnett A . The role of GLP-1 mimetics and basal insulin analogues in type 2 diabetes mellitus: guidance from studies of liraglutide. Diabetes Obes Metab. 2011; 14(4):304-14. PMC: 3488291. DOI: 10.1111/j.1463-1326.2011.01523.x. View

16.

Levin P, Mersey J, Zhou S, Bromberger L . Clinical outcomes using long-term combination therapy with insulin glargine and exenatide in patients with type 2 diabetes mellitus. Endocr Pract. 2011; 18(1):17-25. DOI: 10.4158/EP11097.OR. View

17.

Tzefos M, Olin J . Glucagon-like peptide-1 analog and insulin combination therapy in the management of adults with type 2 diabetes mellitus. Ann Pharmacother. 2010; 44(7-8):1294-300. DOI: 10.1345/aph.1P047. View

18.

Lind M, Jendle J, Torffvit O, Lager I . Glucagon-like peptide 1 (GLP-1) analogue combined with insulin reduces HbA1c and weight with low risk of hypoglycemia and high treatment satisfaction. Prim Care Diabetes. 2011; 6(1):41-6. DOI: 10.1016/j.pcd.2011.09.002. View

19.

Levin P, Wei W, Wang L, Pan C, Douglas D, Baser O . Combination therapy with insulin glargine and exenatide: real-world outcomes in patients with type 2 diabetes. Curr Med Res Opin. 2012; 28(3):439-46. DOI: 10.1185/03007995.2012.654850. View

20.

Buse J, Bergenstal R, Glass L, Heilmann C, Lewis M, Kwan A . Use of twice-daily exenatide in Basal insulin-treated patients with type 2 diabetes: a randomized, controlled trial. Ann Intern Med. 2010; 154(2):103-12. DOI: 10.7326/0003-4819-154-2-201101180-00300. View