Exenatide therapy in insulin-treated type 2 diabetes and obesity

Abstract

Exenatide therapy in insulin-treated type 2 diabetes and obesity was associated with very significant reductions in weight and insulin doses. Exenatide should be considered in people with type 2 diabetes on insulin and have obesity, weight gain and poor glycaemic control.

Liraglutide reverses pronounced insulin-associated weight gain, improves glycaemic control and decreases insulin dose in patients with type 2 diabetes: a 26 week, randomised clinical trial (ELEGANT)

“…Neither the presence nor the severity of these events was related to the magnitude of weight loss or HbA 1c reduction. The withdrawal rate due to adverse events was much lower in our study than in others [17,24,27], possibly because we monitored patients every 4-6 weeks and allowed them to remain on a lower liraglutide dose when needed. This could also have prevented a higher rate of hypoglycaemia in the liraglutide-treated group, the absence of which has been described previously [17,19,22,23,25].…”

“…Some previous studies, mostly observational, have investigated the effect of adding GLP-1 analogues to existing insulin treatment in patients with type 2 diabetes [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Our study differs from previous randomised controlled trials (RCTs) in that this is the first RCT where liraglutide was added to reverse weight gain in fairly well controlled patients, while all other trials added GLP-1 analogues to improve glycaemic control, and reported results on body weight as secondary outcomes, showing mixed results [16,17,19,23,[25][26][27].…”

“…During every visit, participants were asked to report adverse events, body weight was measured on a calibrated scale (with the participant in light underwear), blood pressure was measured, and insulin dose was adjusted using a specific algorithm (adapted from the Wolverhampton protocol) [24]. According to this protocol, insulin dose was adjusted with −2 to +6 U per injection, aiming at fasting glucose levels of 4.0-6.5 mmol/l, and premeal (or postprandial) values of ≤8.0 mmol/l.…”

“…However, GLP-1 analogues are expensive, have gastrointestinal side effects, and lack long-term safety and efficacy data, which renders it important to select those patients that are most likely to benefit from this therapy. Previous studies on the combination of GLP-1 analogues and insulin all focused on glycaemic benefit, with some reporting additional weight loss and others stable body weight [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Furthermore, most studies are either placebo controlled or observational and do not compare clinically relevant treatment strategies.…”

Contrasting Effects of Lixisenatide and Liraglutide on Postprandial Glycemic Control, Gastric Emptying, and Safety Parameters in Patients With Type 2 Diabetes on Optimized Insulin Glargine With or Without Metformin: A Randomized, Open-Label Trial

“…Several prandial agents have been shown to help patients with T2D achieve HbA 1c targets when given in combination with basal insulin (4,(38)(39)(40)(41)(42)(43), and treatment intensification with a rapidacting insulin on top of basal insulin is commonly recommended for control of PPG excursions (2,44). However, more intensive insulin regimens are associated with hypoglycemia and weight gain, which can result in poor treatment acceptance and reduced compliance (45)(46)(47)(48).…”