The Role of Adjunctive Exenatide Therapy in Pediatric Type 1 Diabetes

Vandana S. Raman, MD; Kimberly J. Mason, RN; Luisa M. Rodriguez, MD; Krishnavathana Hassan, MD; Xiaoying Yu, MS; Kisa Bomgaars, MD; Rubina A. Heptulla, MD


Diabetes Care. 2010;33(6):1294-1296. 

In This Article

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.[3] Postprandial hyperglycemia and hypoglycemia[4,5] continue to create impediments to management. Even the closed-loop system fails to normalize postprandial hyperglycemia.[6] 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.[7] Physiological GLP-1 enhances insulin secretion, delays gastric emptying, and suppresses glucagon. But because of its short half-life,[8] it is unsuitable for clinical application.

Exenatide is a long-acting GLP-1 receptor agonist and acts similarly to native GLP-1.[9] Exenatide is effective in decreasing postprandial hyperglycemia in type 2 diabetes.[10] 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.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.