Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Exenatide is an incretin mimetic that acts through glucagon-like peptide 1 receptor accepted as a successful novel glucose-lowering agent in type 2 diabetes. The aim of this study was to explore the possible predictive factors for exenatide efficacy among baseline characteristics of type 2 diabetic patients. We observed basic anthropometric measurements, laboratory findings and diabetic complications in ninety-one type 2 diabetic patients starting exenatide therapy. There were forty-six (50.5%) male and forty-five (49.5%) female patients, median age 58 (31-76) years, body mass index 38.95}4.35 kg/m2, duration of diabetes 10 (1-30) years and HbA1c level 8.3}1.4%. Thirty (33%) patients stopped therapy because of glycemic dysregulation during 105 (21-390) days on therapy. These patients differed statistically significantly from those that continued therapy according to the following seven variables: higher fasting glucose blood concentration (11.5 mmol/L (5.6-20) vs. 10.2 mmol/L (5-19), higher serum creatinine concentration (93 μmol/L (44-149) vs. 72 μmol/L (44-124), more frequent diabetic complications including retinopathy (56.7% vs. 27.9%), chronic kidney disease (43.7% vs. 24.7%), coronary artery disease (53.3% vs. 31.1%) and peripheral artery disease (60% vs. 34.4%), and less often concomitant metformin and exenatide therapy (62% vs. 82%). Bivariate logistic regression identified peripheral artery disease, coronary artery disease, retinopathy, and chronic kidney disease as risk factors for glycemic dysregulation on exenatide therapy. We found reasonable to consider that a higher rate of microvascular and macrovascular complications may indicate failure of exenatide therapy in the majority of patients.Eksenatid je inkretinski mimetik koji djeluje putem receptora proteina nalik glukagonu 1, široko prihvaćen kao uspješan novi lijek u terapiji šećerne bolesti tipa 2. Svrha ovoga istraživanja bila je istražiti moguće čimbenike predviđanja učinkovitosti terapije analizom osnovnih nalaza među bolesnicima sa šećernom bolešću tipa 2. Provedena je analiza antropometrijskih obilježja, laboratorijskih nalaza i evaluacija dijabetičnih komplikacija kod 91 bolesnika koji su započeli terapiju eksenatidom. Bilo je 46 (50,5%) bolesnika muškog spola i 45 (49,5%) ženskog spola; medjian dobi bio je 58 (31-76) godina, indeks tjelesne mase 38,95}4,35 kg/m2, trajanje šećerne bolesti 10 (1-30) godina s prosječnom vrijednosti HbA1c 8,3}1,4%. Tridesetoro (33%) bolesnika prekinulo je terapiju zbog loše regulacije glikemije tijekom 105 (21-390) dana. Sedam varijabli statistički ih je razlikovalo od skupine koja je postigla zadovoljavajuću glukoregulaciju na eksenatidu: više vrijednosti glukoze natašte (11,5 mmol/L (5,6-20) prema 10.2 mmol/L (5-19), više vrijednosti kreatinina u serumu (93 μmol/L (44-149) prema 72 μmol/L (44-124), viša učestalost razvijenih dijabetičnih komplikacija: retinopatije (56,7% prema 27,9%), kronične bubrežne bolesti (43,7% prema 24,7%), koronarne arterijske bolesti (53,3% prema 31,1%) i periferne arterijske bolesti (60% prema 34,4%), te rjeđa upotreba metformina u kombinaciji s eksenatidom (62% prema 82%). Bivarijatna logistička regresija identificirala je perifernu arterijsku bolest, koronarnu arterijsku bolest, retinopatiju i kroničnu bubrežnu bolest kao statistički značajne čimbenike rizika za disregulaciju glikemije na terapiji eksenatidom. Navedeni rezultati navode na zaključak kako bi razvijene mikrovaskularne i makrovaskularne komplikacije mogle biti čimbenik koji predviđa neuspjeh glukoregulacije eksenatidom
