Clinical Experience with Exenatide: Case series of patients switched from insulin therapy to exenatide. — ASN Events
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Clinical Experience with Exenatide: Case series of patients switched from insulin therapy to exenatide. (#261)

Bethany Crinall 1 , Sara Baqar 2 , Fiona Bodey 3 , Leo Rando 1 , Peter R Ebeling 4
  1. Endocrinology, Western Health, Footscray/Sunshine, Victoria, Australia
  2. Endocrinology, Austin Health, Heidelberg, Victoria, Australia
  3. Endocrinology, Alfred Health, Prahran, Victoria, Australia
  4. Endocrinology, Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia

Background:

Exenatide treatment for type 2 diabetes (T2DM) has benefits for both weight reduction and improvement in glycocylated haemoglobin A1c (HbA1c)1 23  .We report on a select group of patients, who were switched from insulin to exenatide due to clinical concerns about progressive weight gain, and/or failure to achieve glycaemic control.

Aims:

To identify adult patients with T2DM who benefit from switching from insulin to exenatide.

Methods:

We conducted a retrospective observational review of electronic medical records of patients switched from insulin to exenatide 10mcg twice daily for at least six months, who attended regular clinical review in the study period. Data collected included rationale for changing to exenatide, insulin dose, changes in HbA1c and weight.

Patients were considered responders if they completed six months of treatment and: i) weight decreased (≥1kg) with stable HbA1c (±0.5%); ii) HbA1c improved with stable weight; or iii) weight decreased and HbA1c improved.

Results:

Eighteen patients met study criteria. Ten ceased exenatide prior to the end of the study period; three due to failure of glycaemic control, seven due to side-effects of exenatide, gastrointestinal (6), pancreatic dysfunction (1).

Of the eight patients included in the final analysis, four were responders. Compared with non-responders, at baseline responders weighed on average 14.8kg less, had a mean HbA1c 1.1% lower and used 71units less insulin per day (Table).

Excess weight gain was the indication for the switch in all responders, who achieved a mean weight loss of 10.9kg and all maintained a stable HbA1c (mean change -0.2%).

121-Exenatide%20switch.jpg Conclusion:

Our pilot data suggest patients who may benefit from a change from insulin to exenatide for treatment of type 2 diabetes include those on lower doses of insulin, with a mildly increased HbA1c in whom significant weight loss is likely to result. This now needs to be confirmed in a prospective study.

  1. Deepson S Shyangdan, Pamela L Royle, Christine Clar, Pawana Sharma, Norman R Waugh Glucagon-like peptide analogues for type 2 diabetes mellitus: systematic review and meta-analysis BMC Endocrine Disorders 2010, 10:20
  2. Heine RJ, Van Gaal LF, Johns D, Mihm MJ, Widel MH, Brodows RG et al. (2005). Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes: a randomized trial. Ann Intern Med143 (8): 559–69
  3. Buse JB, Bergenstal RM, Glass LC, Heilmann CR, Lewis MS et al: Use of Twice-Daily Exenatide in Basal Insulin–Treated Patients With Type 2 Diabetes: A Randomized, Controlled Trial Ann Intern Med. 2011;154:103-112.