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Objective:To evaluate the effect of Exenatide on plasma glucose , insulin incretion, insulin sensitivity and body fat in poorly controlled type 2 diabetes patients using oral antidiabetic drug Metformin and Sulfonylurea.Meathods:10 cases ( mean age 51.10±10.87 years, mean duration of 6.00±5.58 years, mean glycated hemoglobin 8.20±1.26%, mean BMI 25.25±3.67kg/m2) of poorly controlled type 2 diabetes patients using oral antidiabetic drug Metformin or Sulfonylure from Dalian Central Hospital in February 2010 to August 2010 participated in this study. 5μg exenatide was injected subcutaneously 2 times together with the original basis of oral hypoglycemic agents for one month following 10μg subcutaneously 2 times injection. Hyperinsulinemic - euglycemic clamp technique assess fluctuations in plasma glucose, insulin sensitivity , insulin incretion in the first phage. The parameters included BMI, WHR and HbA1c also were measured before and after treatment. Data analysis were performed using SPSS 16.0.Results 1. After 1 months’treatment, MBG, HAUC and MAGE were significantly decreased than before, respectively [11.11±1.34vs8.08±0.82mmol/L,2.70±1.14vs 0.76±0.65mmol/L and 5.26±2.89vs2.35±0.93mmol/L(all above P <0.05)]. MODD was also decreased but no statistical difference (2.21±0.95vs1.64±0.87mmol/L). Compared with before treatment, HbA1c was also significantly decreased (8.23±1.09vs6.66±0.72% P <0.05), and Standard rate of HbA1c≤7% and HbA1c≤6.5% were 55.6% and 44.4% respectively after 3 months’treatment.2. After two weeks’treatment, there were no changes of the plsma glucose of 0,3,5,7,10min and insulin incretion of the first phage. The plasma glucose of 0,3,5,7,10min were respectively 8.63±1.25vs7.30±0.95 ,17.36±1.34vs 15.68±1.55,17.04±1.78vs14.72±1.66,16.16±1.29vs14.34±1.51,15.49±1.23 vs13.50±1.40(all above P <0.05),plasma insulin of the first insulin incretion 0,3,5,7,10min were respectively13.71±4.22vs16.53±8.96,12.80±4.06vs23.1±17.81,9.7 ±5.77vs21.99±16.59,10.93±5.74 vs 21.80±13.2,13.45±7.41vs33.51±26.21(5、7、10min P <0.05,0、3min P >0.05)before and after 3 months’treatment. The M values of glucose utilization were 3.19±1.39vs4.18±1.89 before and after two weeks’treatment and 3.19±1.39vs 4.42±1.54mg/min/kg before and after 3 months’treatment(all above P <0.05). The value of acute insulin reaction (AIR) were -0.86vs0.10mmol/L(P >0.05)before and after two weeks’treatment,and -0.86vs6.24 mmol/L(P <0.05)before and after 3 months’treatment.≤6.5% were 55.6% and 44.4% respectively after 3 months’treatment.3. Before and after 3 months’treatment, the body weight were 81.77±7.18vs 79.05±8.54kg, body mass index (BMI) were 27.88±2.11vs26.82±2.29kg/m2,the percentage of body fat tissue were 30.27±6.77vs27.10±6.96%, the percentage of fat tissue of waist to hip were 0.95±0.02vs0.93±0.03,the area of Visceral fat were 134.27±22.83vs117.03±18.12(all above P <0.05), the waistline were 91.57±7.41vs89.57±6.68cm, the Hip circumference were 103.14±6.44vs103.00±5.92cm. the Waist-hip ratio(WHR) were 0.89±0.04vs0.87±0.03(all above P >0.05).4. During the treatment of exenatide, 10 patients had no nocturnal hypoglycemia and severe hypoglycemia, but one patient exit from the test for cann’t endure nausea.Conclusion:Exenatide can effectively control the level of plasma glucose of patients which being poorly controlled by oral antidiabetic drug Metformin or Sulfonylurea, decreased the level of HbA1C, increase the standard rate , reduce the fluctuations of plasma glucose , improve the insulin increation of the first phage, improve the insulin sensitivity, lower the body weight and Subcutaneous and visceral fat , and had no nocturnal hypoglycemia and severe hypoglycemia.
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