Exenatide safe, effective for hospitalized patients with T2D

  • Fayfman M & al.
  • Diabetes Care
  • 24 Jan 2019

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Short-acting exenatide (Byetta), alone or with basal insulin, is safe and improves glycemic control in general medicine and surgery inpatients with type 2 diabetes (T2D).

Why this matters

  • Guidelines recommend basal-bolus insulin regimens for hospitalized patients with T2D, but these regimens are inconvenient and can cause hypoglycemia.

Study design

  • Multicenter, open-label trial, 150 patients with blood glucose (BG) 140-400 mg/dL randomly assigned to receive 5 μg twice daily exenatide alone or combined with basal insulin alone or basal-bolus regimen.
  • Funding: AstraZeneca.

Key results

  • Overall mean hospital BGs:
    • exenatide alone: 177.1 mg/dL;
    • exenatide+basal-bolus: 166.1 mg/dL; and
    • exenatide+basal insulin: 154.1 mg/dL (P=.03 overall).
  • Proportion of readings in target 70-180 mg/dL range:
    • exenatide: 62.3%;
    • exenatide+basal-bolus: 63.3%; 
    • exenatide+basal insulin: 77.7% (P=.005 vs basal-bolus; P=.07 vs exenatide alone).
  • Hypoglycemia (BG
  • exenatide: 0%;
  • exenatide+basal-bolus: 12%; and 
  • exenatide+basal insulin: 6% (P=.06 overall).
  • Nausea and vomiting, respectively (n):
    • exenatide: 5 and 1;
    • exenatide+basal-bolus: 1 and 0; and
    • exenatide+basal insulin: 5 and 3 (P=.017 overall).
  • 3 participants (all exenatide alone) discontinued because of gastrointestinal side effects (P=.029).
  • No significant differences in hospital length of stay (exenatide+basal 5.0 vs exenatide alone 4.0 vs exenatide+basal-bolus 4.0 days; P=.23).
  • Limitations

    • Small sample sizes.
    • No masking.

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