Diabetes & Metabolism Journal

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Exenatide versus Insulin Lispro Added to Basal Insulin in a Subgroup of Korean Patients with Type 2 Diabetes Mellitus: Kun-Ho Yoon, Elise Hardy, Jenny Han; Diabetes Metab J. 2017;41(1):69-74. Published online December 26, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.1.69

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Background

The prevalence of type 2 diabetes mellitus (T2DM) and obesity is increasing in Korea. Clinical studies in patients with T2DM have shown that combining the glucagon-like peptide-1 receptor agonist exenatide twice daily with basal insulin is an effective glucose-lowering strategy. However, these studies were predominantly conducted in non-Asian populations.

Methods

We conducted a subgroup analysis of data from a multinational, 30-week, randomized, open-label trial to compare the effects of exenatide twice daily (n=10) or three times daily mealtime insulin lispro (n=13) among Korean patients with T2DM inadequately controlled (glycosylated hemoglobin [HbA1c] >7.0%) on metformin plus optimized insulin glargine.

Results

Exenatide twice daily and insulin lispro both reduced HbA1c (mean −1.5% and −1.0%, respectively; P<0.01 vs. baseline). Fasting glucose and weight numerically decreased with exenatide twice daily (−0.7 mmol/L and −0.7 kg, respectively) and numerically increased with insulin lispro (0.9 mmol/L and 1.0 kg, respectively). Minor hypoglycemia occurred in four patients receiving exenatide twice daily and three patients receiving insulin lispro. Gastrointestinal adverse events were the most common with exenatide twice daily treatment.

Conclusion

This analysis found treatment with exenatide twice daily improved glycemic control without weight gain in Korean patients with T2DM unable to achieve glycemic control on metformin plus basal insulin.

Citations

Citations to this article as recorded by

The Role of Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes in Asia
Ju-Ming Lu
Advances in Therapy.2019; 36(4): 798. CrossRef
Efficacy of different antidiabetic drugs based on metformin in the treatment of type 2 diabetes mellitus: A network meta‐analysis involving eight eligible randomized‐controlled trials
Yan Peng, Shu‐Hong Chen, Xiao‐Nan Liu, Qing‐Yun Sun
Journal of Cellular Physiology.2019; 234(3): 2795. CrossRef
Injectable Therapy for Diabetes Mellitus: Glucagon-Like Peptide-1 Receptor Agonist
Inkuk Lee, Eun Seok Kang
The Journal of Korean Diabetes.2019; 20(3): 149. CrossRef
Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association
Hyun Jin Kim
The Journal of Korean Diabetes.2018; 19(1): 35. CrossRef
Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association
Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
The Korean Journal of Internal Medicine.2017; 32(6): 947. CrossRef
Glucagon-like peptide-1 mimetics, optimal for Asian type 2 diabetes patients with and without overweight/obesity: meta-analysis of randomized controlled trials
Fang Zhang, Lizhi Tang, Yuwei Zhang, Qingguo Lü, Nanwei Tong
Scientific Reports.2017;[Epub] CrossRef
Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association
Hyun Jin Kim, Seok O Park, Seung-Hyun Ko, Sang Youl Rhee, Kyu-Yeon Hur, Nan-Hee Kim, Min Kyong Moon, Byung-Wan Lee, Jin Hwa Kim, Kyung Mook Choi
Diabetes & Metabolism Journal.2017; 41(6): 423. CrossRef
Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017
Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
The Korean Journal of Internal Medicine.2017; 32(6): 967. CrossRef
Antihyperglycemic Agent Therapy for Adult Patients with Type 2 Diabetes Mellitus 2017: A Position Statement of the Korean Diabetes Association
Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
Diabetes & Metabolism Journal.2017; 41(5): 337. CrossRef
Insulin Therapy for Adult Patients with Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association, 2017
Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu-Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
Diabetes & Metabolism Journal.2017; 41(5): 367. CrossRef

Effects of a 6-Month Exenatide Therapy on HbA1c and Weight in Korean Patients with Type 2 Diabetes: A Retrospective Cohort Study: Juyoung Shin, Jin-Sun Chang, Hun-Sung Kim, Sun-Hee Ko, Bong-Yun Cha, Ho-Young Son, Kun-Ho Yoon, Jae-Hyoung Cho; Diabetes Metab J. 2012;36(5):364-370. Published online October 18, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.5.364

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Abstract PDF PubReader

Background

While many studies have shown the good efficacy and safety of exenatide in patients with diabetes, limited information is available about exenatide in clinical practice in Korean populations. Therefore, this retrospective cohort study was designed to analyze the effects of exenatide on blood glucose level and body weight in Korean patients with type 2 diabetes mellitus.

Methods

We reviewed the records of the patients with diabetes who visited Seoul St. Mary's Hospital and for whom exenatide was prescribed from June 2009 to October 2011. After excluding subjects based on their race/ethnicity, medical history, whether or not they changed more than 2 kinds of oral hypoglycemic agents with exenatide treatment, loss to follow-up, or whether they stopped exenatide therapy within 6 months, a total of 52 subjects were included in the final analysis.

Results

The mean glycated hemoglobin (HbA1c) level and weight remarkably decreased from 8.5±1.7% to 6.7±1.0% (P<0.001) and from 82.3±15.8 kg to 78.6±16.3 kg (P<0.001), respectively. The multiple regression analysis indicated that the reduction in HbA1c level was significantly associated with a shorter duration of diabetes, a higher baseline HbA1c level, and greater weight reduction, whereas weight loss had no significant correlation with other factors. No severe adverse events were observed.

Conclusion

These results suggest that a 6-month exenatide injection therapy significantly improved patients' HbA1c levels and body weights without causing serious adverse effects in Korean patients with type 2 diabetes.

Citations

Citations to this article as recorded by

Recellularization via electroporation therapy of the duodenum combined with glucagon-like peptide-1 receptor agonist to replace insulin therapy in patients with type 2 diabetes: 12-month results of a first-in-human study
Celine B.E. Busch, Suzanne Meiring, Annieke C.G. van Baar, Frits Holleman, Max Nieuwdorp, Jacques J.G.H.M. Bergman
Gastrointestinal Endoscopy.2024; 100(5): 896. CrossRef
Clinical and Genetic Predictors of Glycemic Control and Weight Loss Response to Liraglutide in Patients with Type 2 Diabetes
Artemis Kyriakidou, Angeliki V. Kyriazou, Theocharis Koufakis, Yiannis Vasilopoulos, Maria Grammatiki, Xanthippi Tsekmekidou, Iakovos Avramidis, Stefanos Baltagiannis, Dimitrios G. Goulis, Pantelis Zebekakis, Kalliopi Kotsa
Journal of Personalized Medicine.2022; 12(3): 424. CrossRef
Insulin receptor signaling and glucagon-like peptide 1 effects on pancreatic beta cells
Nunzia Caporarello, Cristina Parrino, Vincenzo Trischitta, Lucia Frittitta, Claudia Miele
PLOS ONE.2017; 12(8): e0181190. CrossRef
Exenatide versus Insulin Lispro Added to Basal Insulin in a Subgroup of Korean Patients with Type 2 Diabetes Mellitus
Kun-Ho Yoon, Elise Hardy, Jenny Han
Diabetes & Metabolism Journal.2017; 41(1): 69. CrossRef
Acarbose reduces body weight irrespective of glycemic control in patients with diabetes: results of a worldwide, non-interventional, observational study data pool
Oliver Schnell, Jianping Weng, Wayne H.-H. Sheu, Hirotaka Watada, Sanjay Kalra, Sidartawan Soegondo, Noriyuki Yamamoto, Rahul Rathod, Cheryl Zhang, Wladyslaw Grzeszczak
Journal of Diabetes and its Complications.2016; 30(4): 628. CrossRef
Determining Predictors of Early Response to Exenatide in Patients with Type 2 Diabetes Mellitus
Muhammad Khan, Jing Ouyang, Karen Perkins, Sunil Nair, Franklin Joseph
Journal of Diabetes Research.2015; 2015: 1. CrossRef
The Role of Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes: Understanding How Data Can Inform Clinical Practice in Korea
Seungjoon Oh, Suk Chon, Kyu Jeong Ahn, In-Kyung Jeong, Byung-Joon Kim, Jun Goo Kang
Diabetes & Metabolism Journal.2015; 39(3): 177. CrossRef
Tolerability, effectiveness and predictive parameters for the therapeutic usefulness of exenatide in obese, Korean patients with type 2 diabetes
Sun Ok Song, Kwang Joon Kim, Byung‐Wan Lee, Eun Seok Kang, Bong Soo Cha, Hyun Chul Lee
Journal of Diabetes Investigation.2014; 5(5): 554. CrossRef
From endocrine to rheumatism: do gut hormones play roles in rheumatoid arthritis?
C.-Y. Chen, C.-Y. Tsai
Rheumatology.2014; 53(2): 205. CrossRef
Early use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in Type 2 diabetes
Stuart A. Ross, Jane Ballantine
Current Medical Research and Opinion.2013; 29(12): 1617. CrossRef

The Effects of Exendin-4 on IRS-2 Expression and Phosphorylation in INS-1 Cells.: Ji Hyun Kim, Ji Won Kim, Sung Yoon Jeon, Heon Seok Park, Dong Sik Ham, Young Hye You, Seung Hwan Lee, Jae Hyoung Cho, Mi Ja Kang, Kang Woo Lee, Hyuk Sang Kwon, Kun Ho Yoon, Bong Yun Cha, Kwang Woo Lee, Sung Koo Kang, Ho Young Son; Korean Diabetes J. 2008;32(2):102-111. Published online April 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.2.102

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Abstract PDF: BACKGROUND
Insulin receptor substrate 2 (IRS-2) is a key regulator of beta cell proliferation and apoptosis. This study was aimed to investigate effect of the glucolipotoxicity on apoptosis in INS-1 cell, and the effect of Exendin-4, a GLP-1 receptor agonist, on IRS-2 expression in the glucolipotoxicity induced INS-1 cell. The goal was to discover the new action mechanism and function of Exendin-4 in beta cell apoptosis. METHOD: INS-1 cells were cultured in glucolipotoxic condition for 2, 4 or 6 days and were categorized as G groups. Another group in which 50 nM Exendin-4 was added to INS-1 cells, cultured in glucolipotoxic condition, were named as Ex-4 groups. We investigated the expression of IRS-2 by RT-PCR, phosphorylated IRS-2 and phosphorylated Akt protein levels by western blot. We measured the apoptosis ratio of INS-1 cell in glucolipotoxic condition by TUNEL staining in both groups. RESULT: IRS-2 expression of INS-1 cells decreased with correlation to the time of exposure to glucolipotoxic condition. pIRS-2 and pAkt protein levels decreased in the similar pattern in glucolipotoxicity group. However, this effect of glucolipotoxicity on INS-1 cell was inhibited by the Exendin-4 treatment. In the Ex-4 groups, IRS-2 expression, pIRS-2 and pAkt protein levels remained at the similar level to low glucose condition state. Also, apoptosis induced by glucolipotoxicity was suppressed by Exendin-4 treatment significantly. CONCLUSION: We showed that the long-term treatment of Exendin-4 inhibited the apoptosis of beta cells significantly in glucolipotoxic condition and that this effect of Exendin-4 was related with IRS-2 and Akt among the beta cell's intracellular signal transduction pathway.

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