Journal of Endocrinological Investigation

, Volume 41, Issue 5, pp 539–547 | Cite as

The effects of add-on exenatide to insulin on glycemic variability and hypoglycemia in patients with type 1 diabetes mellitus

Original Article
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Abstract

Objective

To investigate the effect of add-on exenatide to insulin on glycemic excursion and the counter-regulatory hormone in response to hypoglycemia in patients with type 1 diabetes mellitus (T1DM).

Methods

30 patients with T1DM were recruited and randomly assigned to exenatide + insulin-treated group (group 1, n = 15) or insulin-only-treated group (group 2, n = 15) for 4 weeks. All patients had continuous glucose monitor system (CGMS) applied at before (week-0) and after (week-4) treatment to evaluate the glycemic variability. All patients had an arginine-stimulated test at before and after treatment. Six patients from each group also had hypoglycemic clamp test to assess counter-regulatory hormone level.

Results

Patients in the exenatide group had significant reductions in body weight, body mass index (BMI), total insulin dose, bolus insulin dose, fructosamine, and glycemic excursion after 4 weeks’ treatment. Compared with patients in group 2, the mean amplitude of glycemic excursion (MAGE) and coefficient of variation (CV) of exenatide group decreased significantly. Similarly, a significant decrease of glucagon (GLC) in the arginine-stimulated test was found in group 1. No significant changes of GLC, growth hormone (GH), cortisol (COR), epinephrine (E), and norepinephrine (NE) were found in both groups during hypoglycemia clamp test. However, patients who had residual islet function in group 1 showed an upward trend of basic C-peptide (C-P) and GLC during the hypoglycemia period.

Conclusion

Although exenatide could inhibit glucagon secretion during euglycemia or hyperglycemia in patients with T1DM, it has no effect on GLC and counter-regulatory hormones during hypoglycemia clamp in patients with no functional residual islet test.

Keywords

Type 1 diabetes mellitus Exenatide Glycemic excursion 
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Notes

Acknowledgements

This study received financial support from the Science Association fund of Nanjing (201303005), JiangSu, China.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts interest to declare.

Ethical approval

The research study was approved by the ethics committee at Nanjing First Hospital, Nanjing, China.

Informed consent

Our research involved human participants who had obtained informed consent.

Supplementary material

40618_2017_765_MOESM1_ESM.doc (136 kb)
Supplementary material 1 (DOC 135 kb)

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Copyright information

© Italian Society of Endocrinology (SIE) 2017

Authors and Affiliations

  1. 1.Department of EndocrinologyNanjing First Hospital, Nanjing Medical UniversityNanjingChina
  2. 2.Department of NephrologyNanjing Pukou Central HospitalNanjingChina
  3. 3.National Heart Centre SingaporeNational Heart Research Institute SingaporeSingaporeSingapore
  4. 4.Department of MedicineNational University of SingaporeSingaporeSingapore

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