The effects of twice-daily GLP-1 analogue injections added on continuous subcutaneous insulin infusion (CSII) in patients with poorly controlled type 2 diabetes (T2DM) were unknown. After optimization of blood glucose in the first 3 days by CSII during hospitalization, patients with poorly controlled T2DM were randomized to receive CSII combined with injections of exenatide or placebo for another 3 days. A total of 51 patients (30 in exenatide and 21 in placebo groups) with mean A1C 11% were studied. There was no difference in mean glucose but a significant higher standard deviation of plasma glucose (SDPG) was found in the exenatide group (50.51 ± 2.43 vs. 41.49 ± 3.00 mg/dl, p = 0.027). The improvement of incremental area under the curve (AUC) of glucose and insulinogenic index (Insulin 0-peak / Glucose 0-peak ) in 75 g oral glucose tolerance test was prominent in the exenatide group (p < 0.01). The adiponectin level was significantly increased with exenatide added on (0.39 ± 0.32 vs. −1.62 ± 0.97 μg/mL, in exenatide and placebo groups, respectively, p = 0.045). In conclusion, the add-on of GLP-1 analogue to CSII increased glucose variability and the β -cell response in patients with poorly controlled T2DM.In the poorly controlled patients with type 2 diabetes mellitus (DM), insulin therapy is the treatment of choice to control glucose levels on target. Actually, however, the general control rate is not good which is partially due to the complex etiology in type 2 DM. Glucagon-like peptide-1 (GLP-1) is secreted from enteroendocrine L cells of the intestinal mucosa and is released into the portal circulation in response to meal ingestion 1 through posttranslational processing of proglucagon by prohormone convertase-1 in its secretary cells 2 . GLP-1 enhances insulin secretion and inhibits glucagon release in a glucose-dependent manner, prompting the development of GLP-1-based therapies for the treatment of diabetes 3 . GLP-1-based diabetes therapies affect glucose control through several mechanisms, including slowed gastric emptying, regulation of postprandial glucagon, reduction of food intake, and enhancement of glucose-dependent insulin secretion without the risk of hypoglycemia 4 . The combination with twice-daily exenatide has been shown to improve glycemic control in patients with type 2 diabetes that had been treated with basal-only insulin regimen
5. But the effect of GLP-1 analogue on intensive insulin therapy for patients with type 2 DM remains unknown. To study the effect of GLP-1 analogue in insulinized type 2 DM patients, the first priority is to optimize insulin therapy. Continuous subcutaneous insulin infusion (CSII) or insulin pump is a viable choice for patients with type 1 or type 2 DM who want close-to-physiologic insulin treatment 6 . By means of the insulin pump therapy during hospitalization, we can optimize the sugar control profile efficiently 7 . We can further evaluate the clinical response under GLP-1 analogue precisely in these patients with poorly controlled type 2 DM.