Exenatide is an injectable drug that promotes the production of insulin and inhibits production of glucagon. The National Institute for Health and Clinical Excellence (NICE) has just published a guideline stating that prolonged-release (weekly) exenatide injections should be used as third line of therapy in type 2 diabetes.
In type 2 diabetes inadequately controlled on metformin and either sulphonyluea or thiazolidinediones, prolonged-release exenatide should be offered to improve glycemic control.
This is a confirmation of NICE Technology Appraisal TA248.
The guidance defines “inadequate control” as HbA1c > 7.5%. Exenatide should be offered to such patients who are already using two oral therapies as outlined above, and who fall into one of the following categories:
- a body mass index (BMI) of 35 kg/m2 or higher in those of European family origin (with appropriate adjustment for other ethnic groups) and specific psychological or medical problems associated with high body weight, or
- a BMI below 35 kg/m2, and therapy with insulin would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities.
In addition, patients who are only on one oral therapy (either metformin or a sulphonylurea) may be offered exenatide if they are not able to take an alternative additional oral therapy.
- NICE is a signatory of the AGREE Trust
The following documents will be useful: