title: Add on Exenatide Treatment is Beneficial in Poorly Controlled Obese Type 2 Diabetics under Intensive Insulin Regimens.
abstract: Background:Intensive insulin treatment is bothersome in obese patients with type 2 diabetes mellitus. High insulin dosages further increase weight gain and the risk of hypoglycemia. Glucagon like peptide-1 receptor agonists decrease the insulin need, cause weight loss and reduce the risk of hypoglycemia. There is limited data about the effect of exenatide on obese diabetics under intensive insulin regimens.Methods:This retrospective case series report the clinical outcomes of 23 obese (13 morbidly obese) patients with uncontrolled type 2 diabetes mellitus (Age=59±10.44 years, body mass index 41.1±6.8 kg/m2, HbA1c 9.9±1.5%), under high dose (94.1±39.6 unit) intensive insulin. Exenatide twice daily was added for a mean follow-up period of 11.22±7.01 (3-30) months. Intensive insulin regimens were continued in 7 patients while the others were switched to basal insulin during the follow-up.Results:During the follow-up, mean HbA1c levels of the patients significantly improved (p=0.019), along with the significant decrease in body mass index and the total insulin need (p<0.001 for both). Baseline insulin dosages were significantly higher in the intensive regimen group (p=0.013) while other demographical and clinical characteristics were similar. No significant difference was present between the groups regarding the alterations of HbA1c, body mass index and the reduction in total insulin dosages.Conclusion:Add on exenatide appears to be a rational treatment modality in uncontrolled obese patients with type 2 diabetes mellitus despite intensive insulin regimens. Further prospective randomized studies with longer follow-up periods are recommended.
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Alper
authors.initials: A
authors.lastname: Sönmez
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Dinç
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Taşlıpınar
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Aydogan
authors.initials: A
authors.lastname: Aydoğdu
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Coskun
authors.initials: C
authors.lastname: Meriç
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Başaran
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Cem
authors.initials: C
authors.lastname: Haymana
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Orhan
authors.initials: O
authors.lastname: Demir
authors.affiliation: Gulhane Military Medical Academy, Department of Nephrology, School of Medicine, Ankara/TURKEY.
authors.forename: İlker
authors.initials: İ
authors.lastname: Yılmaz
authors.affiliation: Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Azal
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D000077270:Exenatide; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000188:drug therapy*; D010455:Peptides / Q000008:administration & dosage*; D012189:Retrospective Studies; 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