Clinical Observations of Exenatide Treatment

Controlled clinical trials have demonstrated the effectiveness of exenatide in reducing glucose and weight (1,2,3,4). We herein report our initial clinical experience.

Clinic charts of the first 200 patients consecutively treated were retrospectively analyzed. Of these patients, 22% were lost to follow-up, noncompliant, or chose not to continue for reasons other than side effects. Thirteen percent discontinued treatment due to side effects including nausea (8%), urticaria (2%), jitteriness not associated with hypoglycemia (1.5%), abdominal pain (1%), and hypoglycemia (0.5%). In the single case of hypoglycemia, a self-monitored glucose of <60 mg/dl was documented and the patient was not taking a hypoglycemic medication. Urticaria was localized to the injection site; appearance and disappearance correlated with the time action of exenatide and resolved upon discontinuing the medication. One patient continued exenatide despite uritcaria, and the urticaria became generalized.

For the 65% continuing treatment for at least 12 weeks, other diabetes concurrent medications were none (1.5%), thiazolidinedione (TZD) (45%), sulfonylurea (28%), metformin (40.5%), and insulin (21%). Mean weight loss at 12 weeks was 3.89 kg in the entire group and 4.23 kg in those on TZDs. The mean HbA_1c (A1C) decreased from 6.95 to 6.57% (P < 0.005). The mean diabetic concurrent medication dosages were reduced in those on sulfonylureas (64%), metformin (22%), TZDs (20%), and insulin (21%). In all cases, the reduction was significant (P < 0.05).

We believe the greater weight loss at 12 weeks compared with published studies at 30 weeks (1,2,3,4) (3.89 vs. 0.9–2.5 kg) is related to the encouragement and nutritional and activity support given to our patients. We are unsure whether one can expect the rate of weight loss to continue. The weight loss despite concurrent treatment with TZDs is encouraging since weight gain is a common problem with TZD treatment (5). Our results demonstrate not only a significant reduction in A1C but also the significant reduction in dosage of other antiglycemic concurrent medications. The incidence of urticaria needs to be verified in larger observational studies.