Background: Exenatide ER (BydureonTM), a weekly GLP-1 agonist, was recently approved under Pharmaceutical Benefits Scheme for use in T2DM. It stimulates glucose-dependent insulin secretion, suppresses glucagon secretion, slows gastric emptying and promotes satiety – actions which promote weight loss. A 10-month clinic audit was undertaken to assess real world experience with Bydureon in our Diabetes Service.
Methodology: 125 patients with T2D attending Blacktown Hospital Diabetes Clinics or Joint Specialist Case Conference with General Practice who started Bydureon were audited. Data was collected on initiation and at the 6-8 week follow-up. Data collection is ongoing.
Results: 31 patients had complete data at time of writing; mean age was 58.7, 61.3% males (n=19). Most (67.7%,n=21) had <10yr duration of diabetes. HbA1c (mean±SEM) fell after Bydureon initiation (9.2±0.31% to 7.9±0.20%, p<0.01). There was a short-term trend towards weight loss of 1.04kg (89.2±4.31kg vs. 88.1±4.38kg, p<0.20). 38.7% (n=12) were on insulin. Of these, half of them were able to remain off insulin and they all had diabetes 10years or less. 32.3% (n=10) had a history with mental health conditions. 7 of 10 dropped their HbA1c by at least 1.3%. 6 of 10 lost weight between 1.2-10.7kg. Main adverse effects were injection site lumps/pruritus, mild nausea, diarrhoea in 19% (n=6). 29% (n=9) had to discontinue Bydureon, all due to suboptimal glycaemic control. Of these, 6 had diabetes >10years and 6 were on insulin.
Discussion: We confirmed the expected efficacy of Bydureon on glycaemic control. The weight loss may be more significant with a longer follow-up than 8 weeks. Selection criteria for patients for Bydureon will highly influence whether glycaemic control can be well maintained without insulin. Patients who were not well controlled were easily converted to Exenatide (ByettaTM) and insulin. With more data and longer follow-up of these patients a more complete picture will emerge.