Abstract and Introduction
Objective Exenatide improves postprandial glycemic excursions in type 2 diabetes. Exenatide could benefit type 1 diabetes as well. We aimed to determine an effective and safe glucose-lowering adjuvant exenatide dose in adolescents with type 1 diabetes.
Research Design and Methods Eight subjects completed a three-part double-blinded randomized controlled study of premeal exenatide. Two doses of exenatide (1.25 and 2.5 μg) were compared with insulin monotherapy. Prandial insulin dose was reduced by 20%. Gastric emptying and hormones were analyzed for 300 min postmeal.
Results Treatment with both doses of exenatide versus insulin monotherapy significantly reduced glucose excursions over 300 min (P < 0.0001). Exenatide administration failed to suppress glucagon but delayed gastric emptying (P < 0.004).
Conclusions Adjunctive exenatide therapy reduces postprandial hyperglycemia in adolescents with type 1 diabetes. This reduction in glucose excursion occurs despite reduction in insulin dose. We suggest that exenatide has therapeutic potential as adjunctive therapy in type 1 diabetes.
Intensive insulin therapy delays/prevents complications associated with type 1 diabetes.[1,2] However, insulin monotherapy fails to achieve normoglycemia. Postprandial hyperglycemia and hypoglycemia[4,5] continue to create impediments to management. Even the closed-loop system fails to normalize postprandial hyperglycemia. Additional therapies to insulin are needed to achieve optimal glycemic control.
Glucagon-like peptide (GLP)-1 is an incretin secreted in response to nutrient ingestion. Physiological GLP-1 enhances insulin secretion, delays gastric emptying, and suppresses glucagon. But because of its short half-life, it is unsuitable for clinical application.
Exenatide is a long-acting GLP-1 receptor agonist and acts similarly to native GLP-1. Exenatide is effective in decreasing postprandial hyperglycemia in type 2 diabetes. However, there are few studies using exenatide in type 1 diabetes and none in adolescents. The objective of our study was to examine the effect of adjuvant premeal exenatide and insulin on postprandial glucose in type 1 diabetes and establish an effective and safe glucose-lowering dose.
Diabetes Care. 2010;33(6):1294-1296. © 2010 American Diabetes Association, Inc.
Cite this: The Role of Adjunctive Exenatide Therapy in Pediatric Type 1 Diabetes - Medscape - Jun 01, 2010.