title: Exenatide therapy in insulin-treated type 2 diabetes and obesity.
abstract: BACKGROUND
  Exenatide, a GLP-1 analogue, is used in combination with oral anti-diabetic agents in type 2 diabetes and obesity, and promotes weight loss. Exenatide use in combination with insulin in insulin-treated type 2 diabetes and obesity is unlicensed in the UK and outcomes are unclear.
  
  
  OBJECTIVE
  To assess the effectiveness of exenatide in insulin-treated type 2 diabetes with obesity.
  
  
  METHODS
  This prospective study included 174 consecutive patients with insulin-treated type 2 diabetes and obesity initiated on exenatide in our out-patient, between October 2007 and November 2008. Weight, BMI, HbA1c, serum fructosamine, total cholesterol, HDL-cholesterol and insulin doses were recorded at baseline, 3, 6 and 12 months. Side effect profiles were recorded.
  
  
  RESULTS
  Fourteen patients discontinued exenatide before 3 months of initiation, because of side effects, and were excluded. Data were analysed on remaining 160 people all of whom completed 6 months and 57 completed 12 months treatment. Mean weight loss was 10.7 +/- 5.7 kg and 12.8 +/- 7.5 kg (P < 0.001) at 6 and 12 months. Insulin doses dropped significantly (mean 144 +/- 90 U/day at baseline to 51 +/- 55 U/day and 55 +/- 53 U/day at 6 and 12 months). At 3 months, 25% came off insulin. There was little change in HbA1c.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, WV10 0QP, UK. ananth.nayak@nhs.net
authors.forename: U A
authors.initials: UA
authors.lastname: Nayak
authors.forename: J
authors.initials: J
authors.lastname: Govindan
authors.forename: V
authors.initials: V
authors.lastname: Baskar
authors.forename: D
authors.initials: D
authors.lastname: Kalupahana
authors.forename: B M
authors.initials: BM
authors.lastname: Singh
mesh_terms: D000368:Aged; D001835:Body Weight / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D000077270:Exenatide; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy*; D010455:Peptides / Q000627:therapeutic use*; D011446:Prospective Studies; D014688:Venoms / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D010455:Peptides; D014688:Venoms; D000077270:Exenatide