Exenatide added to insulin therapy: A retrospective review of clinical practice over two years in an academic endocrinology outpatient setting

Yoon, Nancy M.; Cavaghan, Melissa K.; Brunelle, Rocco L.; Roach, Paris

doi:10.1016/j.clinthera.2009.07.021

Cited by 103 publications

(124 citation statements)

References 14 publications

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“…Some previous studies, mostly observational, have investigated the effect of adding GLP-1 analogues to existing insulin treatment in patients with type 2 diabetes [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Our study differs from previous randomised controlled trials (RCTs) in that this is the first RCT where liraglutide was added to reverse weight gain in fairly well controlled patients, while all other trials added GLP-1 analogues to improve glycaemic control, and reported results on body weight as secondary outcomes, showing mixed results [16,17,19,23,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…However, GLP-1 analogues are expensive, have gastrointestinal side effects, and lack long-term safety and efficacy data, which renders it important to select those patients that are most likely to benefit from this therapy. Previous studies on the combination of GLP-1 analogues and insulin all focused on glycaemic benefit, with some reporting additional weight loss and others stable body weight [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Furthermore, most studies are either placebo controlled or observational and do not compare clinically relevant treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

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Liraglutide reverses pronounced insulin-associated weight gain, improves glycaemic control and decreases insulin dose in patients with type 2 diabetes: a 26 week, randomised clinical trial (ELEGANT)

et al. 2014

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Aims/hypothesis The best treatment strategy for a patient with type 2 diabetes who shows pronounced weight gain after the introduction of insulin treatment is unclear. We determined whether addition of a glucagon-like peptide-1 (GLP-1) analogue could reverse pronounced insulin-associated weight gain while maintaining glycaemic control, and compared this with the most practised strategy, continuation and intensification of standard insulin therapy. Methods In a 26-week, randomised controlled trial (ELEGANT), conducted in the outpatient departments of one academic and one large non-academic teaching hospital in the Netherlands, adult patients with type 2 diabetes with ≥4% weight gain during short-term (≤16 months) insulin therapy received either open-label addition of liraglutide 1.8 mg/day (n=26) or continued standard therapy (n=24). A computer-generated random number list was used to allocate treatments. Participants were evaluated every 4-6 weeks for weight, glycaemic control and adverse events. The primary endpoint was between-group weight difference after 26 weeks of treatment (intention to treat). In five patients (19%), insulin could be completely discontinued. Liraglutide was well tolerated; no severe adverse events or severe hypoglycaemia occurred. Conclusions/interpretation In patients with pronounced insulin-associated weight gain, addition of liraglutide to their treatment regimen reverses weight, decreases insulin dose and improves glycaemic control, and hence seems a valuable therapeutic option compared with continuation of standard insulin treatment. Trial registration ClinicalTrials.gov NCT01392898 Funding The study was funded by Novo Nordisk. Results

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Liraglutide reverses pronounced insulin-associated weight gain, improves glycaemic control and decreases insulin dose in patients with type 2 diabetes: a 26 week, randomised clinical trial (ELEGANT)

et al. 2014

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“…11 The first reported case of acute pancreatitis in which exenatide appeared to be the etiologic agent was in 2006. 15,16 Pancreatitis has also been reported in clinical trials of the GLP-1R agonist, liraglutide. 17 However a retrospective analysis reported that there was no increased risk of acute pancreatitis associated with the use of increatin-based drugs.…”

Section: Discussionmentioning

confidence: 99%

Sitagliptin and Acute Pancreatitis: Cases and Literature Review

Köroğlu¹,

Songür²,

Ersoy³

et al. 2012

Turkiye Klinikleri J Med Sci

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cute pancreatitis is a severe disease with an overall mortality of approximately 5%, though in subpopulations with necrotizing pancreatitis and infected necrosis, mortality may be as high as 17% and 30%, respectively. [1][2][3] The most common etiologies are excessive alcohol use and gallstone disease, comprising 70-80% of all cases. Other etiologies include autoimmune disease, iatrogenic injury, inflammatory bowel disease, infections, inherited disorders, neoplasia, structural abnormalities, toxins, trauma, ischaemia and drug toxicity.1-4 Drug-induced pancreatitis is remarkably rare, given the large number of drugs prescribed. Due to its rarity and the lack of unique clinical characteristics, the true epidemiology and risk factors for drug-induced pancreatitis remain unknown. The diagnosis Turkiye Klinikleri J Med Sci 2012;32 (3) 859 Sitagliptin and Acute Pancreatitis:Cases and Literature Review A AB BS ST TR RA AC CT T Acute pancreatitis is the rapid onset inflammation of the pancreas. Medications are rare but important and rising cause of acute pancreatitis and account for approximately 2% of all cases. Sitagliptin is a potent and selective dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of patients with type 2 diabetes mellitus and acts by increasing active incretin hormone concentrations. Adverse effects including constipation, nausea, nasopharyngitis, urinary tract infection and dizziness were reported. We reported a case with acute pancreatitis that seems to be induced by sitagliptin.K Ke ey y W Wo or rd ds s: : Sitagliptin; incretins; drug toxicity; acute necrotizing pancreatitis Ö ÖZ ZE ET T Akut pankreatit, pankreasın hızlı gelişen yangısıdır. İlaçlar, nadir, önemli ve gitgide daha fazla dikkat çeken akut pankreatite neden olabilir ve tüm olguların yaklaşık %2'sinden sorumludur. Sitagliptin, tip 2 diabetes mellituslu hastaların tedavisinde kullanılan güçlü ve selektif bir dipeptidil peptidaz-4 (DDP-4) inhibitörüdür ve aktif inkretin hormon konsantrasyonunu artırarak etki eder. Konstipasyon, bulantı, nazofarenjit, üriner sistem enfeksiyonu ve baş dönmesi, bu ilacın bildirilen yan etkileri arasındadır. Bu makalede, sitagliptinin neden olduğu düşünülen bir akut pankreatit olgusu sunulmaktadır.A An na ah ht ta ar r K Ke el li im me el le er r: : Sitagliptin; inkretinler; ilaç toksisitesi; akut nekrotizan pankreatit T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 12 2; ;3 32 2( (3 3) ): :8 85 59 9--6 64 4

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“…Of these, three evaluated exenatide when added to existing oral therapy or insulin, 37,38,41 and three specifically evaluated exenatide when added to insulin. [68][69][70] Of the insulin studies, one compared outcomes with exenatide to insulin glargine. 68 Of five studies that evaluated glycemic control, 37,38,41,69,70 all observed that exenatide therapy was associated with significant reductions in HbA1c ranging from -0.3% to -0.9%.…”

Section: Retrospective Outcomes Analysesmentioning

confidence: 99%

“…This review focuses on six retrospective studies that included 100 or more patients with T2DM and that evaluated glycemic control, weight change, blood pressure change, or the occurrence of hypoglycemic events over 16 weeks to 27 months (Table 2). 37,38,41,[68][69][70] All studies conducted a pre-post evaluation of exenatide's effect on select study parameters. Of these, three evaluated exenatide when added to existing oral therapy or insulin, 37,38,41 and three specifically evaluated exenatide when added to insulin.…”

Section: Retrospective Outcomes Analysesmentioning

confidence: 99%

Exenatide: Review of its Role as Adjunctive Therapy in Patients with Type 2 Diabetes

Bellows

Hunter²,

McAdam‐Marx³

2011

Clinical Medicine Reviews in Vascular Health

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Abstract:Exenatide was the first glucagon like peptide-1 (GLP-1) agonist approved for treatment in patients with type 2 diabetes. Clinical trials and real-world studies of exenatide, a subcutaneous injection given twice per day, indicate that it significantly reduces hemoglobin A1c values and weight with a low risk of hypoglycemia. Exenatide is generally well tolerated, but transient nausea and vomiting are commonly occurring side effects. Given this profile, exenatide has been shown to be cost effective relative to insulin glargine. Thus, exenatide is a treatment option that should be considered for patients with type 2 diabetes that is uncontrolled on one or more oral agents and for which additional weight gain and hypoglycemia are undesirable.

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Exenatide added to insulin therapy: A retrospective review of clinical practice over two years in an academic endocrinology outpatient setting

Cited by 103 publications

References 14 publications

Liraglutide reverses pronounced insulin-associated weight gain, improves glycaemic control and decreases insulin dose in patients with type 2 diabetes: a 26 week, randomised clinical trial (ELEGANT)

Liraglutide reverses pronounced insulin-associated weight gain, improves glycaemic control and decreases insulin dose in patients with type 2 diabetes: a 26 week, randomised clinical trial (ELEGANT)

Sitagliptin and Acute Pancreatitis: Cases and Literature Review

Exenatide: Review of its Role as Adjunctive Therapy in Patients with Type 2 Diabetes

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