Feasibility of once weekly exenatide‐LAR and enhanced diabetes care in Indigenous Australians with type 2 diabetes (Long‐acting‐Once‐Weekly‐Exenatide laR‐SUGAR, ‘Lower SUGAR’ study)

Abstract

Background Diabetes is 3‐4 times more prevalent in Indigenous Australians with blood glucose levels often above target range. Once weekly formulations of exenatide(exenatide‐LAR) have demonstrated significantly greater improvements in glycaemic management with no increased risk of hypoglycaemia and with reductions in bodyweight but have not been studied in Indigenous Australians. Aims To assess the feasibility and metabolic effects of once weekly supervised injection of exenatide‐LAR in addition to standard care in Indigenous Australians with type 2 diabetes. Methods Two communities in Central Australia with longstanding specialist clinical outreach services were allocated by random coin toss to receive once‐weekly exenatide‐LAR injection with weekly nurse review and adjustment of medication for 20 weeks (community with exenatide‐LAR) or to weekly nurse review in addition to standard care over 20 weeks (community without exenatide‐LAR). The primary outcome was the feasibility of an intensive diabetes management model of care with and without weekly supervised exenatide‐LAR. Secondary outcomes included change in HbA1c. Results Thirteen participants from the community with exenatide‐LAR and nine participants from the community without exenatide‐LAR were analysed. Eighty‐five percent of individuals in the community with exenatide‐LAR and 67% in the community without exenatide‐LAR attended more than half of clinic visits. Median difference in the change in HbA1c from baseline to final visit, adjusted for baseline HbA1c, between the community with exenatide‐LAR and the community without exenatide‐LAR was −3.1%, 95% CI (−5.80%, −0.38%; P = 0.03). Conclusions Weekly exenatide‐LAR combined with weekly nurse review demonstrated greater improvements in HbA1c, highlighting its potential for use in remote communities.

Challenges and Opportunities for Diabetes Care in Indigenous People: A Scoping Review

“…The reviewed articles are summarized in Schematic 1. Most of the studies were conducted in the Australian outback with five aboriginal tribes (12,(20)(21)(22)(23), one Victorian native (24), and one Torres Strait Islander native (23); in Canada with four Ontario natives (25)(26)(27)(28), three Alberta natives (28,29), one Vancouver native (28), and one Atikamekw native (30); in Guatemala with one Solol native (31) and one Mayan Kaqchikel native (32); in Queensland with one Cunnamulla native (33); and one in the United States with Alaska and Indians natives (34). The majority of research sites were the community (73.68%, n = 14), clinics (15.78%, n = 3), and primary health centers (10.52%, n = 2), as presented in Table 1.…”