title: Clinical effectiveness of exenatide in diabetic patients waiting for bariatric surgery.
abstract: BACKGROUND
  Bariatric surgery constitutes the most effective treatment for severely obese type 2 diabetic patients. Exenatide is a glucagon-like peptide 1 receptor agonist that can improve glycemic control and cause weight loss in patients with type 2 diabetes. Clinical experience with exenatide in obese patients with type 2 diabetes waiting for bariatric surgery has not been reported. The aim of the study was to evaluate, in clinical practice, weight and metabolic effects of exenatide (after 3 and 6 months) in patients with type 2 diabetes and obesity waiting for bariatric surgery.
  
  
  METHODS
  A total of 100 diabetic adult subjects with a BMI ≥ 35 kg/m(2) were included. Primary endpoints were changes in weight and HbA1c after 6 months of treatment. Secondary endpoints were changes from baseline of a variety of clinical measures (triglycerides levels, blood pressure, and waist circumference). Data were analyzed at 3 and 6 months of follow-up.
  
  
  RESULTS
  Treatment for 6 months with exenatide decreased significantly body weight (-12.5 kg) and waist circumference (-13 cm). Twenty percent of patients reduced their BMI under 35 kg/m(2) and significantly improved their metabolic profile (HbA1c <7 %). Significant and maintained decreases in HbA1c of 1 % were observed in the 3 and 6 months cohorts. Triglycerides levels and blood pressure also decreased from baseline to the end of the study. Treatment was discontinued in 19 % of patients mainly due to drug inefficacy (6 %) or adverse events (4 %).
  
  
  CONCLUSIONS
  Exenatide twice daily (BID) leads to early, robust, and significant weight loss in a subset of patients with diabetes and severe obesity before bariatric surgery. Clinical trials are needed to confirm the benefits of GLP-1 agonists in type 2 diabetic obese patients or high-risk super-obese patients waiting for bariatric surgery.
authors.affiliation: Department of Endocrinology, Hospital Rey Juan Carlos, Madrid, Spain, paloma.iglesias@hospitalreyjuancarlos.es.
authors.forename: P
authors.initials: P
authors.lastname: Iglesias
authors.forename: S
authors.initials: S
authors.lastname: Civantos
authors.forename: B
authors.initials: B
authors.lastname: Vega
authors.forename: I
authors.initials: I
authors.lastname: Pavón
authors.forename: G
authors.initials: G
authors.lastname: Guijarro
authors.forename: S
authors.initials: S
authors.lastname: Monereo
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D000077270:Exenatide; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000819:agonists; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D010455:Peptides / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D014688:Venoms / Q000627:therapeutic use*; D055105:Waist Circumference; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D010455:Peptides; D014688:Venoms; D052216:Glucagon-Like Peptide 1; D000077270:Exenatide