The Role of Adjunctive Exenatide Therapy in Pediatric Type 1 Diabetes

Abstract

OBJECTIVEExenatide improves postprandial glycemic excursions in type 2 diabetes. Exenatide could benefit type 1 diabetes as well. We aimed to determine an effective and safe glucose-lowering adjuvant exenatide dose in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODSEight subjects completed a three-part double-blinded randomized controlled study of premeal exenatide. Two doses of exenatide (1.25 and 2.5 μg) were compared with insulin monotherapy. Prandial insulin dose was reduced by 20%. Gastric emptying and hormones were analyzed for 300 min postmeal.RESULTSTreatment with both doses of exenatide versus insulin monotherapy significantly reduced glucose excursions over 300 min (P < 0.0001). Exenatide administration failed to suppress glucagon but delayed gastric emptying (P < 0.004).CONCLUSIONSAdjunctive exenatide therapy reduces postprandial hyperglycemia in adolescents with type 1 diabetes. This reduction in glucose excursion occurs despite reduction in insulin dose. We suggest that exenatide has therapeutic potential as adjunctive therapy in type 1 diabetes.

Adjuvant Liraglutide and Insulin Versus Insulin Monotherapy in the Closed-Loop System in Type 1 Diabetes

“…3,24,25 This results in a very complicated treatment algorithm especially if using multiple-hormonal therapy in CL. 25 Hence, our research has focused on studying newer analogs such as exenatide 9,10 (twice daily) and now liraglutide (once daily), to improve postprandial glucose concentrations in type 1 diabetes, thus reducing treatment complexity. As improved treatment options emerge, efficacy in CL must be investigated.…”

“…Based on a power of .8, alpha of .05, correlation coefficient of r = .5, 9 and Figure 1. Design of the study evaluating overnight and daytime closed-loop delivery.…”

“…8 Our earlier study showed reduction in postprandial glucose levels following a preprandial injection of exenatide in adolescents with type 1 diabetes. 9 Subsequently, we demonstrated that exenatide with CL was effective in reducing postprandial hyperglycemia compared to CL with insulin monotherapy. 10 Liraglutide is a human GLP-1 receptor agonist with 1 amino acid substitution and C-16 palmitic acid chain attached via a glutamyl spacer.…”

Czy leki inkretynowe i inhibitory SGLT-2 mogą znaleźć zastosowanie w leczeniu cukrzycy typu 1?

“…pokazują, że natywny GLP-1 zmniejsza hiperglikemię poposił-kową również w cukrzycy typu 1, prawdopodobnie przez wpływ na supresję glukagonu. Podobny efekt zaobserwowano po iniekcjach eksanatydu u młodych pacjentów z cukrzycą typu 2 [23]. W badaniach z zastosowaniem liraglutydu udało się także wykazać jego korzystny wpływ na kontrolę glikemii poposiłkowej.…”

Alpha cell function in type 1 diabetes

“…[44][45][46] Varanasi et al showed that the administration of a GLP-1 analogue in individuals with well controlled type 1 diabetes mellitus improved mean fasting glucose and decreased glycaemic excursions. These improvements in glycaemic control were evident after one week of treatment and persisted for the 24-week trial.…”