Skip Navigation
American College of Physicians Logo
  • Subscribe
  • Submit a Manuscript
  • Sign In
    Sign in below to access your subscription for full content
    INDIVIDUAL SIGN IN
    Sign In|Set Up Account
    You will be directed to acponline.org to register and create your Annals account
    INSTITUTIONAL SIGN IN
    Open Athens|Shibboleth|Log In
    Annals of Internal Medicine
    SUBSCRIBE
    Subscribe to Annals of Internal Medicine.
    You will be directed to acponline.org to complete your purchase.
Annals of Internal Medicine Logo Menu
  • Latest
  • Issues
  • Channels
  • CME/MOC
  • In the Clinic
  • Journal Club
  • Web Exclusives
  • Author Info
Advanced Search
  • ‹ PREV ARTICLE
  • This Issue
  • NEXT ARTICLE ›
Summaries for Patients |18 January 2011

Does Adding Exenatide to Insulin Treatment Benefit Patients With Type 2 Diabetes? Free

  • ‹ PREV ARTICLE
  • This Issue
  • NEXT ARTICLE ›
Jump To
  • Full Article
  • FULL ARTICLE
    • What is the problem and what is known about it so far?
    • Why did the researchers do this particular study?
    • Who was studied?
    • How was the study done?
    • What did the researchers find?
    • What were the limitations of the study?
    • What are the implications of the study?
  • Figures
  • Tables
  • Supplements
  • Audio/Video
  • Summary for Patients
  • Clinical Slide Sets
  • CME / MOC
  • Comments
  • Twitter Link
  • Facebook Link
  • Email Link
More
  • LinkedIn Link
  • CiteULike Link

What is the problem and what is known about it so far?

Type 2 diabetes mellitus interferes with the body's ability to store energy from food, resulting in high blood sugar levels that can lead to kidney failure, blindness, and heart disease. Insulin helps the body convert food to stored energy and keeps blood sugar levels within the normal range. In type 2 diabetes, body tissues are resistant to the effects of insulin and patients lack effective insulin levels required to keep their blood sugar levels normal. Prescription pills and, if needed, insulin injections can help some patients. However, sugar levels may remain high despite these treatments.
An injectable medication called exenatide may benefit these patients. Exenatide triggers an increase in insulin secretion, which helps reduce blood sugar levels. It also slows digestion and leads to a decrease in food intake, leading to weight loss, unlike many diabetes medications that cause weight gain.

Why did the researchers do this particular study?

Research on the benefits and harms of combining exenatide with insulin in patients with type 2 diabetes was sparse.

Who was studied?

261 adults with type 2 diabetes who were taking long-acting, once-daily insulin (glargine) alone or with diabetes pills (metformin or pioglitazone); had a body mass index less than the cutoff for extreme obesity (45 kg/m2 or less); and had a hemoglobin A1c (HbA1c) level of 7.1% to 10.5%. Hemoglobin A1c is a blood test that measures blood sugar control over the previous 3 months. Lower levels mean better control, and the recommended target is less than 7%.

How was the study done?

Participants were randomly assigned to receive exenatide or placebo injections twice daily plus insulin glargine and, if they were already taking them, diabetes pills. In both groups (exenatide and placebo), insulin treatment was optimized by increasing or decreasing the dose to try to achieve fasting blood sugar targets.

What did the researchers find?

Exenatide treatment resulted in greater decreases in blood sugar levels; 60% of participants receiving exenatide achieved normal HbA1c levels compared with 35% of those receiving placebo. Exenatide recipients needed smaller increases in their insulin dose than placebo recipients. Exenatide recipients lost an average of 4 pounds, whereas placebo recipients gained an average of 2 pounds. Nausea (41% vs. 8%), diarrhea (18% vs. 8%), vomiting (18% vs. 4%), headache (14% vs. 4%), and constipation (10% vs. 2%) were increased with exenatide compared with placebo, but episodes of hypoglycemia were similar between groups.

What were the limitations of the study?

Of the 138 patients who received exenatide, 13 stopped treatment because of undesired adverse effects. The study was only 6 months long; longer-term effects of combining exenatide with insulin treatment remain unknown.

What are the implications of the study?

Adding exenatide to insulin glargine treatment can help decrease blood sugar levels in patients with uncontrolled type 2 diabetes and can lead to modest weight loss. However, the adverse effects and need for injection may be intolerable for some patients.

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

This feature is available only to Registered Users

Subscribe/Learn More
Submit a Comment

0 Comments

PDF
Not Available
Citations
Citation

Does Adding Exenatide to Insulin Treatment Benefit Patients With Type 2 Diabetes?. Ann Intern Med. 2011;154:I–40. doi: 10.7326/0003-4819-154-2-201101180-00301

Download citation file:

  • RIS (Zotero)
  • EndNote
  • BibTex
  • Medlars
  • ProCite
  • RefWorks
  • Reference Manager

© 2018

×
Permissions

Published: Ann Intern Med. 2011;154(2):I-40.

DOI: 10.7326/0003-4819-154-2-201101180-00301

0 Citations

See Also

Use of Twice-Daily Exenatide in Basal Insulin–Treated Patients With Type 2 Diabetes: A Randomized, Controlled Trial
View MoreView Less

Related Articles

The Effect of Adding Exenatide to a Thiazolidinedione in Suboptimally Controlled Type 2 Diabetes: A Randomized Trial
Annals of Internal Medicine; 146 (7): 477-485
Exenatide Therapy for Type 2 Diabetes
Annals of Internal Medicine; 146 (7): I-18
Narrative Review: Ketosis-Prone Type 2 Diabetes Mellitus
Annals of Internal Medicine; 144 (5): 350-357
Exenatide versus Insulin Glargine in Patients with Suboptimally Controlled Type 2 Diabetes: A Randomized Trial
Annals of Internal Medicine; 143 (8): 559-569
View MoreView Less

Journal Club

In type 2 diabetes, weekly semaglutide reduced HbA1c and increased weight loss more than weekly exenatide ER
Annals of Internal Medicine; 168 (8): JC46
Exenatide did not reduce major cardiovascular outcomes in type 2 diabetes
Annals of Internal Medicine; 167 (12): JC67
Self-monitoring of blood glucose did not improve HbA1c or QoL at 1 year in non–insulin-treated type 2 diabetes
Annals of Internal Medicine; 167 (8): JC46
In type 2 diabetes treated with high-dose insulin, liraglutide reduced HBA1c
Annals of Internal Medicine; 165 (8): JC40
View MoreView Less

Related Point of Care

Type 2 Diabetes
Annals of Internal Medicine; 162 (5): ITC1
Type 2 Diabetes
Annals of Internal Medicine; 152 (5): ITC3-1
Type 2 Diabetes
Annals of Internal Medicine; 146 (1): ITC1-1
Diabetic Ketoacidosis
Annals of Internal Medicine; 152 (1): ITC1-1
View MoreView Less

Related Topics

Cardiology
Coronary Risk Factors
Diabetes
Endocrine and Metabolism

Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.

CME/MOC Activity Requires Users to be Registered and Logged In.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
The Comments Feature Requires Users to be Registered and Logged In.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
link to top

Content

  • Home
  • Latest
  • Issues
  • Channels
  • CME/MOC
  • In the Clinic
  • Journal Club
  • Web Exclusives

Information For

  • Author Info
  • Reviewers
  • Press
  • Readers
  • Institutions / Libraries / Agencies
  • Advertisers

Services

  • Subscribe
  • Renew
  • Alerts
  • Current Issue RSS
  • Online First RSS
  • In the Clinic RSS
  • Reprints & Permissions
  • Contact Us
  • Help
  • About Annals
  • About Mobile
  • Patient Information
  • Teaching Tools
  • Annals in the News
  • Share Your Feedback

Awards

  • Personae Photography Prize
  • Junior Investigator Awards
  • Poetry Prize

Other Resources

  • ACP Online
  • Career Connection
  • ACP Advocate Blog
  • ACP Journal Wise

Follow Annals On

  • Twitter Link
  • Facebook Link
acp link acp
silverchair link silverchair

Copyright © 2018 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
INSTITUTIONAL SIGN IN
Open Athens|Shibboleth|Log In
Annals of Internal Medicine
PURCHASE OPTIONS
Buy This Article|Subscribe
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×