Addition of exenatide to insulin therapy in individuals with type 2 diabetes in UK routine clinical practice
Price HC., Gorst C., Ayyagari U., Levy J., Holman RR.
Our aim was to study the impact of adding twice-daily exenatide in obese patients with type 2 diabetes and poor glycaemic control who were taking insulin therapy, either alone or in combination with oral hypoglycaemic agents (OHAs), in routine clinical practice. Outcomes evaluated were glycaemic control, body weight, insulin dose, tolerability, safety and incidence of hypoglycaemia. In an open-label prospective study, twice-daily exenatide was added to existing therapy in individuals with type 2 diabetes, suboptimal glycaemic control (HbA1c > 7% [53mmol/mol]) and obesity (body mass index [BMI] > 30kg/m 2 ), who were receiving insulin therapy alone or in combination with OHA(s). Thirty-one patients (18 male) were mean (SD) age 55.7(8.6)years, weight 114.6(22.0)kg, BMI 39.1(5.6)kg/m 2 , waist circumference 128(13)cm and fasting capillary glucose 11.1(3.4)mmol/L. Median (IQR) known diabetes duration was 10.0(8.0, 17.9)years, HbA1c 9.5(8.8, 10.7)% and daily insulin dose 120(74, 230)units/day. Twenty patients were also taking metformin. One-month data were available for 29 patients, three-month data for 23 patients, six-month data for 28 patients and 12-month data for 21 patients. There was a mean (SD) reduction in weight from 1.1(2.6)kg (p=0.043) at one month to 4.8(7.3)kg (p=0.007) at 12 months, with a maximal reduction at six months (5.3[5.9]kg, p < 0.001). Total daily insulin dose was reduced significantly by 31.8(56.5)units (p=0.010) at one month and 49.5(85.3)units (p=0.015) at 12 months. At three months there was a significant reduction in HbA1c (1.2[1.1]%, p < 0.001) which was not maintained at six or 12 months (0.5[1.8]%, p=0.139, and 0.5[1.9] %, p=0.237, respectively). The only reported adverse event at 12 months was nausea, occurring in two of 15 (13%) patients. No severe episodes of hypoglycaemia were reported throughout the study. Over one year, the addition of exenatide in individuals with type 2 diabetes on insulin therapy promoted weight loss (~4%) with a substantial reduction in insulin dose (~41%), but with a nonsustained significant improvement in glycaemic control at three months only. No serious adverse events or episodes of severe hypoglycaemia were reported. Copyright © 2012 John Wiley & Sons.