Effect of exenatide after short-time intensive insulin therapy on glycaemic remission maintenance in type 2 diabetes patients: a randomized controlled trial

Xiulin Shi,Zhibin Li,Ning Chen,Bing Yan,Weijuan Su,Huijie Zhang,Suhuan Liu,Fangsen Xiao,Shuyu Yang,Xiaoying Li,Mingzhu Lin,Chunlu Liu ,Lei Qi ,Yalin Shi,Liying Wang,Jiali Zeng ,Hang Song ,Wei Liu,Peiying Huang,Xuejun Li

doi:10.1038/s41598-017-02631-1

Abstract

Early short-term intensive insulin (STII) therapy can induce drug-free glycemic remission for up to 1 year in half of newly diagnosed type 2 diabetic mellitus (T2DM) patients. Whether exenatide following STII therapy will induce higher long-term glycaemic remission is currently unknown. To assess the effect of STII+ exenatide therapy, compared with STII only, on maintenance of glycaemic remission in newly diagnosed T2DM patients. In this randomized, parallel-group, open-label, controlled trial, 129 patients (66 in STII+ exenatide group and 63 in STII only group) firstly completed 3-week STII therapy, then STII+ exenatide group was treated with exenatide for 12 weeks further. The cumulative probabilities of 1-year and 2-year glycaemic remission in STII+ exenatide group were 68.2 ± 5.7% and 53.0 ± 6.1%, which were significantly higher than STII only group (36.5 ± 6.1% and 31.8 ± 5.9%) (p-values < 0.001). Patients in STII+ exenatide group, compared with STII only group, showed significantly decreased levels of waist (82.2 (81.0, 83.5) cm v.s. 84.2 (82.7, 85.7) cm, p = 0.048) and HbA1c (5.83 (5.60, 6.06)% v.s. 6.49 (6.20, 6.77)%, p < 0.001) after 12-week exenatide treatment, but these differences disappeared after 1-year and 2-year follow-up. As conclusions, Improved effect of sequential exenatide after STII therapy on maintenance of glycaemic remission only occurred during exenatide treatment and lost upon treatment cessation.

Highlights

Therapy will induce higher long-term glycaemic remission is currently unknown
The present study found that, for newly diagnosed and drug-naive type 2 diabetes mellitus (T2DM) patients who reached glycaemic remission by short-term intensive insulin (STII) therapy, sequential exenatide therapy for 12 weeks induced significantly higher 1-year and 2-year maintenance of glycaemic remission rates compared with STII only therapy
The beneficial effects of sequential exenatide therapy for 12 weeks after STII on maintenance of glycaemic remission and lowering waist and hemoglobin A1c (HbA1c) did not sustain upon cessation of exenatide treatment

Summary

Introduction

Therapy will induce higher long-term glycaemic remission is currently unknown. To assess the effect of STII+ exenatide therapy, compared with STII only, on maintenance of glycaemic remission in newly diagnosed T2DM patients. Whether exenatide following STII therapy, compared with STII only therapy, will induce higher long-term glycaemic remission rate in newly diagnosed T2DM patients is currently unknown.

Results

Conclusion