Abstract
BackgroundWe investigated the changes in blood glucose fluctuation, gastric emptying, and vascular endothelial function by switching from an exenatide twice-daily formulation (BID) to a once-weekly formulation (QW) since the evaluation of postprandial glucose excursion and glycemic variability (GV) by continuous glucose monitoring (CGM) after switching was lacking.MethodsTwenty-nine patients with type 2 diabetes treated with exenatide BID were included in this study and switched to exenatide QW for 24 weeks. GV assessed by CGM, gastric emptying (by 13 C-acetate breath test) and vascular endothelial function (by reactive hyperemia - peripheral arterial tonometry) were evaluated at baseline and 24 weeks after switching.ResultsHbA1c decreased significantly from the baseline to week 24, while postprandial glucose levels after breakfast and dinner significantly increased (both P <0.05). However, the increases in GV indices were modest and not statistically significant at week 24. Vascular endothelial function was also not significantly changed after switching (P >0.05). Gastric emptying was significantly accelerated at week 24 (Tmax 83.4 ± 12.1 min vs. 58.2 ± 16.4 min) (P <0.001) and correlated with increased postprandial glucose levels after breakfast and dinner (both P <0.05).ConclusionsDespite the increase in postprandial glucose associated with accelerated gastric emptying after switching from exenatide BID to QW, change in GV was modest and no significant deterioration in vascular endothelial function was observed after switching. These results support the superiority of treatment with exenatide QW over exenatide BID in clinical practice; however, attention should be paid to the monitoring and management of postprandial glucose levels when selecting exenatide QW.Trial registrationClinical trial registry number; UMIN000016390 and jRCTs031180320.Approval date of Registry and the Registration: December 12, 2014.
Highlights
We investigated the changes in blood glucose fluctuation, gastric emptying, and vascular endothelial function by switching from an exenatide twice-daily formulation (BID) to a once-weekly formulation (QW) since the evaluation of postprandial glucose excursion and glycemic variability (GV) by continuous glucose monitoring (CGM) after switching was lacking
Despite the increase in postprandial glucose associated with accelerated gastric emptying after switching from exenatide twice daily (BID) to QW, change in GV was modest and no significant deterioration in vascular endothelial function was observed after switching
These results support the superiority of treatment with exenatide QW over exenatide BID in clinical practice; attention should be paid to the monitoring and management of postprandial glucose levels when selecting exenatide QW
Summary
We investigated the changes in blood glucose fluctuation, gastric emptying, and vascular endothelial function by switching from an exenatide twice-daily formulation (BID) to a once-weekly formulation (QW) since the evaluation of postprandial glucose excursion and glycemic variability (GV) by continuous glucose monitoring (CGM) after switching was lacking. One of the GLP-1RAs, was developed based on exendin-4 [4], and there are two formulations of exenatide, a twice daily (BID) formulation as a short-acting GLP-1RA, and a once weekly (QW) formulation as a long-acting GLP1RA. We have previously reported that switching from exenatide BID to exenatide QW reduced HbA1c and fasting plasma glucose, and improved beta cell function and treatment satisfaction in Japanese patients with T2DM [5]. Our and other studies reported increased postprandial hyperglycemia after switching, using self-monitoring of blood glucose (SMBG) [5,6,7]; they lacked evaluation of postprandial glucose excursion and glycemic variability (GV) by continuous glucose monitoring (CGM)
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