Effects of a 6-Month Exenatide Therapy on HbA1c and Weight in Korean Patients with Type 2 Diabetes: A Retrospective Cohort Study

Abstract

BackgroundWhile many studies have shown the good efficacy and safety of exenatide in patients with diabetes, limited information is available about exenatide in clinical practice in Korean populations. Therefore, this retrospective cohort study was designed to analyze the effects of exenatide on blood glucose level and body weight in Korean patients with type 2 diabetes mellitus.MethodsWe reviewed the records of the patients with diabetes who visited Seoul St. Mary's Hospital and for whom exenatide was prescribed from June 2009 to October 2011. After excluding subjects based on their race/ethnicity, medical history, whether or not they changed more than 2 kinds of oral hypoglycemic agents with exenatide treatment, loss to follow-up, or whether they stopped exenatide therapy within 6 months, a total of 52 subjects were included in the final analysis.ResultsThe mean glycated hemoglobin (HbA1c) level and weight remarkably decreased from 8.5±1.7% to 6.7±1.0% (P<0.001) and from 82.3±15.8 kg to 78.6±16.3 kg (P<0.001), respectively. The multiple regression analysis indicated that the reduction in HbA1c level was significantly associated with a shorter duration of diabetes, a higher baseline HbA1c level, and greater weight reduction, whereas weight loss had no significant correlation with other factors. No severe adverse events were observed.ConclusionThese results suggest that a 6-month exenatide injection therapy significantly improved patients' HbA1c levels and body weights without causing serious adverse effects in Korean patients with type 2 diabetes.

Determining Predictors of Early Response to Exenatide in Patients with Type 2 Diabetes Mellitus

“…Such findings have been reported in the majority of the literature within this field [26, 27, 30, 31]; however, Song et al also noted significant correlations between changes in HbA1c and the patient's age, levels of serum fasting glucose, and parameters that measure pancreatic- β cell function such as homeostatic model assessment- β (HOMA- β ), levels of insulin at baseline, and both basal and stimulated C-peptide levels [30]. As we were unable to measure variables of insulin secretion, we cannot ascertain whether such a relationship in the changes in HbA1c and these parameters would have existed in our study.…”

“…Additionally, of the participants that did complete 6 months of exenatide therapy, 43.8% failed to achieve the required 11 mmol/mol reduction in HbA1c stipulated by NICE [10]. Such observations reflect those reported by the limited literature presently available with studies reporting primary failure rates within the range of 11.4–33.6%, in addition to secondary failure rates ranging from 39 to 61% [26, 27, 29–31]. Although the rates of both primary and secondary failure rates observed within our study lie within such ranges, it reiterates the clinical significance and need of identifying measures which can delineate whether an individual will respond or not respond to exenatide therapy.…”

“…As we were unable to measure variables of insulin secretion, we cannot ascertain whether such a relationship in the changes in HbA1c and these parameters would have existed in our study. However, with regard to age, no other study has identified such a relationship and despite the study by Shin et al also including cohorts of South Korean type 2 diabetics only, they did not report such an association either [31]. Therefore, this association may simply be exclusive to the study sample used by Song et al [30].…”

“…However, within the existing literature the predictive role of baseline HbA1c determining response to exenatide is shown to differ between studies. Both Anichini et al and Preumont et al report that a higher baseline HbA1c reduces the odds of response [27, 29], yet studies by Anderson et al and Shin et al observed a greater likelihood of response with higher levels of baseline HbA1c [26, 31]. Although results from our study correspond to the latter studies, we believe the differing predictive role of baseline HbA1c observed by Preumont et al and Anichini et al is a result of the definition used to determine response to exenatide.…”

“…However, limited information is currently available which delineates factors that predict whether individuals will respond or not to GLP-1 analogues. At present, the few studies in this area of research have identified that baseline HbA1c appears to be the strongest predictor of response to GLP-1 analogues [26–31]. Nevertheless, such studies are hindered by both small sample sizes and a lack of comparisons at multiple time points.…”