Exenatide should be an option for triple therapy in type 2 not on insulin

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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.

Clinical question:

In type 2 diabetes inadequately controlled on metformin and either sulphonyluea or thiazolidinediones, prolonged-release exenatide should be offered to improve glycemic control.

The evidence:

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.

Appraisal hints

  • NICE is a signatory of the AGREE Trust


The following documents will be useful:

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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