Effect of the Glucagon‐like Peptide‐1 Analogue Exenatide Extended Release in Cats with Newly Diagnosed Diabetes Mellitus

Abstract

BackgroundExenatide extended release (ER) is a glucagon‐like peptide‐1 analogue that increases insulin secretion, inhibits glucagon secretion and induces satiation in humans with type 2 diabetes mellitus. The use of exenatide ER is safe and stimulates insulin secretion in healthy cats.ObjectivesThe objective of this study is to assess the safety of exenatide ER and its effect on body weight, remission and metabolic control in newly diagnosed diabetic cats receiving insulin and a low‐carbohydrate diet.AnimalsThirty client‐owned cats.MethodsProspective placebo‐controlled clinical trial. Cats were treated with exenatide ER or 0.9% saline, administered SC, once weekly. Both groups received insulin glargine and a low‐carbohydrate diet. Exenatide ER was administered for 16 weeks, or in cats that achieved remission it was given for 4 weeks after discontinuing insulin treatment. Nonparametric tests were used for statistical analysis.ResultsCats in the exenatide ER and placebo groups had transient adverse signs including decreased appetite (60% vs. 20%, respectively, P = .06) and vomiting (53% vs. 40%, respectively, P = .715). Body weight increased significantly in the placebo group (P = .002), but not in cats receiving exenatide ER. Cats on exenatide ER achieved remission or good metabolic control in 40% or 89%, respectively, whereas in control cats percentages were 20% or 58% (P = .427 and P = .178, respectively).Conclusion and clinical importanceExenatide ER is safe in diabetic cats and does not result in weight gain. Our pilot study suggests that, should there be an additional clinically relevant beneficial effect of exenatide ER in insulin‐treated cats on rate of remission and good metabolic control, it would likely approximate 20% and 30%, respectively.

Glycemic variability in newly diagnosed diabetic cats treated with the glucagon‐like peptide‐1 analogue exenatide extended release

“…An evaluation of blood glucose curves from a recently published prospective placebo-controlled clinical trial was performed. 17 Cats with newly diagnosed DM admitted from January 2013 to January 2015 to the Clinic for Small Animal Internal Medicine of the University of Zurich and the Department of Veterinary Medical Sciences, University of Bologna were included in the trial. The diagnosis of DM was based on clinical signs (eg, polyuria, polydipsia, weight loss), fasting hyperglycemia, glucosuria, and increased serum fructosamine concentration.…”

“…The diagnosis of DM was based on clinical signs (eg, polyuria, polydipsia, weight loss), fasting hyperglycemia, glucosuria, and increased serum fructosamine concentration. 17,19 Exclusion criteria were previous treatment with insulin or any other antidiabetic medication for >4 weeks before admission, as well as glucocorticoid and progestagen treatment within 3 months prior to admission. Furthermore, cats with concurrent diseases (eg, renal disease, gastrointestinal disorder, heart disease, other endocrinopathies or neoplasia) were excluded.…”

“…15 EER enhances insulin secretion in healthy cats and treatment appears to be safe in both healthy and diabetic cats. 16,17 The use of GLP-1 analogues in diabetic cats has been examined in 2 studies 17,18 and treatment with exenatide is safe, associated with significant weight loss and a decreased requirement for exogenous insulin. 18 Once-weekly administration of the long-acting EER has beneficial effect on remission and metabolic control (no clinical signs, serum fructosamine concentration between 350 and 450 μmol/L, blood glucose concentration between 4.4 and 15 mmol/ L) in insulin-treated cats with DM.…”

“…18 Once-weekly administration of the long-acting EER has beneficial effect on remission and metabolic control (no clinical signs, serum fructosamine concentration between 350 and 450 μmol/L, blood glucose concentration between 4.4 and 15 mmol/ L) in insulin-treated cats with DM. 17 To date, the role of GLP-1 analogues on GV has not been investigated in diabetic cats. The objective of the present study was to evaluate GV in diabetic cats receiving the GLP-1 analogue EER and insulin.…”

Managing feline diabetes: current perspectives

“…In newly diagnosed diabetic cats treated with glargine and a low-carbohydrate diet, 15 cats also treated with extended-release exenatide had improved glycemic control and remission rates compared with 15 cats that received a placebo, though this was not significant. 90 Further studies are required to investigate their cost-effectiveness in diabetic cats.…”