For general medicine and surgery patients, glycemic control can be improved with the use of the short-acting GLP-1 receptor agonist exenatide both with and without basal insulin, according to findings published in Diabetes Care.
Guillermo E. Umpierrez
“Based on their mechanism of action and safety profiles, there has been a great interest in using incretin-based therapies instead of, or complementary to, an insulin-based approach to improve glycemic control in hospitalized patients with diabetes,” Guillermo E. Umpierrez, MD, professor of medicine in the division of endocrinology and metabolism at Emory University School of Medicine and the chief of diabetes and endocrinology at Grady Memorial Hospital in Atlanta, and colleagues wrote. “Use of these agents is attractive in hospitalized patients owing to their metabolic effects, such as glucose-dependent stimulation of insulin secretion and inhibition of glucagon secretion, which leads to improved glycemic control with low rates of hypoglycemia.”
Umpierrez and colleagues conducted a multicenter, prospective, open-label, randomized trial with 150 adults who were hospitalized with noncritically ill conditions at Emory University Hospital, Grady Memorial Hospital in Atlanta, Temple University Hospital in Philadelphia or Vanderbilt University Medical Center in Nashville, Tennessee. Each participant had been diagnosed with type 2 diabetes previously and treated with diet, oral agents or low-dose insulin.
Participants were randomly assigned to in-hospital treatment with exenatide (Byetta, AstraZeneca; n = 47; mean age, 55 years; 49% women; mean blood glucose at admission, 220.7 mg/dL), exenatide with basal insulin (n = 51; mean age, 55 years; 49% women; mean blood glucose at admission, 186.9 mg/dL) or a basal-bolus regimen (n = 52; mean age, 57 years; 50% women; mean blood glucose at admission, 195.1 mg/dL). The researchers assessed mean daily blood glucose concentrations as the primary outcome, but also reported hypoglycemic events, significant hypoglycemia, severe hypoglycemia and hyperglycemic events.
Participants who received exenatide in addition to basal insulin had lower mean blood glucose compared with exenatide therapy by itself (P = .02). The highest proportion of participants to fall within the target range for blood glucose of 70 mg/dL to 180 mg/dL was found in the exenatide plus basal insulin group (77.7%). The basal-bolus (63.3%; P = .005) and exenatide alone (62.3%; P = .07) groups had similar proportions of participants to fall within the range. In addition, participants with exenatide alone (0%) and exenatide plus basal insulin (6%) had less reported hypoglycemia compared with the basal-bolus regimen (12%), but the researchers noted that this did not reach statistical significance.
In terms of efficacy, gastrointestinal adverse effects were low in the entire cohort, and no statistically significant difference was found among the three groups, although there were more reports in both the exenatide alone and exenatide plus basal insulin groups. There was also no major difference between mean length of stay in the hospital for the three groups.
“Our results indicate that exenatide is well-tolerated and can be used safely in non-ICU hospital settings,” the researchers wrote. – by Phil Neuffer
Disclosures: This study was supported by AstraZeneca. Umpierrez reports that he has received unrestricted research support for inpatient studies from AstraZeneca, Merck, Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.