title: Substitution of insulin by exenatide in bad controlled type 2 diabetic patients: efficacy and predictive factors.
abstract: OBJECTIVE
  Exenatide therapy is indicated in type 2 diabetes after failure of oral antidiabetic agents (OAD). The aim of this observational prospective study was to assess efficacy of exenatide, in improving HbA1c of at least of 1% (responders) in type 2 diabetic patients treated previously with insulin.
  
  
  METHODS
  Thirty-six patients (HbA1c >7.5%), with chronic bad glycemic control, were hospitalized to improve glycemia using transient continuous insulin infusion followed by administration of exenatide and OAD agents. In these patients, insulin had been introduced previously because of OAD failure without any sign of severe insulin deficiency.
  
  
  RESULTS
  On the 27 patients analyzed at 3 months, 19 patients were responders (HbA1c: M0: 9.9±1.7%; M3: 7.6±1.2%). Among the 8 non-responders, only 4 deteriorated their HbA1c. After 9 months, 10 patients remained Responders (HbA1c: 7±0.9%). Predictive factors for an improvement of glycemic control were: diabetes duration shorter than 12 years, ratio fasting glycemia/C-peptide less than 1, fasting C-peptide higher than 2.0 µg/L and mean capillary blood glucose after 3 days of exenatide lower than 200 mg/dL. These criteria remained valid in case of a high HbA1c at baseline.
  
  
  CONCLUSIONS
  In patients with no signs of insulin dependence and in case of insulin failure, exenatide associated to OAD may be tried in order to improve glycemic control, this objective was reached by 70% of our patients. Predictive factors for good response, easily available in clinical practice, may help therapeutic choices.
authors.affiliation: Department of Endocrinology, Diabetes, Nutrition and Addictology, Pôle NUDE, HUS, Université de Strasbourg UdS, Strasbourg, France - nathalie.jeandidier@chru-strasbourg.fr.
authors.forename: M
authors.initials: M
authors.lastname: Barthélémy
authors.forename: S
authors.initials: S
authors.lastname: Boullu Sanchis
authors.forename: F
authors.initials: F
authors.lastname: Moreau
authors.forename: N
authors.initials: N
authors.lastname: Reix
authors.forename: M
authors.initials: M
authors.lastname: Pinget
authors.forename: S
authors.initials: S
authors.lastname: Sigrist
authors.forename: N
authors.initials: N
authors.lastname: Jeandidier
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D000077270:Exenatide; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014688:Venoms / Q000008:administration & dosage*
chemical_list: D001786:Blood Glucose; D000077270:Exenatide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D010455:Peptides; D014688:Venoms; C517652:hemoglobin A1c protein, human