Sheffield Catherine A, Kane Michael P, Busch Robert S
Department of Pharmacy Practice, Albany College of Pharmacy, Albany, New York 12208, USA.
Pharmacotherapy. 2007 Oct;27(10):1449-55. doi: 10.1592/phco.27.10.1449.
Exenatide is an incretin mimetic indicated for the treatment of type 2 diabetes mellitus in combination with a sulfonylurea, a thiazolidinedione, metformin, or metformin plus a sulfonylurea or thiazolidinedione. Exenatide lowers postprandial blood glucose levels by stimulating glucose-dependent insulin secretion, inhibiting glucagon secretion, slowing gastric emptying, and increasing satiety. Therapy with exenatide often results in weight loss, which further assists in decreasing insulin resistance. This feature makes the drug an attractive therapeutic option for obese patients. We report the successful off-label use of exenatide in an obese, 40-year-old man with type 1 diabetes and human immunodeficiency virus (HIV) infection who had gastrointestinal intolerance to pramlintide. The patient had experienced a dramatic weight gain secondary to his antiretroviral drugs. This weight gain led to insulin resistance and the development of type 2 diabetes; thus he had characteristics of both types 1 and 2 diabetes, or double diabetes. Before the start of exenatide therapy, he weighed 123 kg, had a body mass index of 42.3 kg/m(2), and had a suboptimal hemoglobin A(1c) value of 8.7%. After 11 months of therapy, the patient lost 24 kg (19.5% of his body weight) and achieved a hemoglobin A(1c) value of 7.3%. His basal insulin requirement was reduced by 25%, and his use of short-acting insulin before breakfast and before dinner was discontinued. In addition, the patient's quality of life substantially improved, as he was able to return to work and exercise after being nearly incapacitated by his weight. To our knowledge, this is the first published case report of the use of exenatide in a patient with type 1 diabetes mellitus or human immunodeficiency virus infection. Given this experience, exenatide may prove to be a useful alternative in selected patients with type 1 diabetes.
艾塞那肽是一种肠促胰岛素类似物，适用于与磺脲类药物、噻唑烷二酮类药物、二甲双胍或二甲双胍加磺脲类药物或噻唑烷二酮类药物联合用于治疗2型糖尿病。艾塞那肽通过刺激葡萄糖依赖性胰岛素分泌、抑制胰高血糖素分泌、减慢胃排空和增加饱腹感来降低餐后血糖水平。使用艾塞那肽治疗通常会导致体重减轻，这进一步有助于降低胰岛素抵抗。这一特性使该药物成为肥胖患者有吸引力的治疗选择。我们报告了艾塞那肽在一名40岁肥胖男性1型糖尿病合并人类免疫缺陷病毒（HIV）感染患者中的成功非标签使用，该患者对普兰林肽有胃肠道不耐受。该患者因抗逆转录病毒药物导致体重急剧增加。这种体重增加导致胰岛素抵抗和2型糖尿病的发生；因此，他同时具有1型和2型糖尿病的特征，即双重糖尿病。在开始艾塞那肽治疗前，他体重123公斤，体重指数为42.3kg/m²，糖化血红蛋白值为8.7%，不太理想。经过11个月的治疗，患者体重减轻了24公斤（占其体重的19.5%），糖化血红蛋白值达到7.3%。他的基础胰岛素需求量减少了25%，并且停止了早餐前和晚餐前短效胰岛素的使用。此外，患者的生活质量大幅提高，因为在因体重几乎丧失能力后，他能够重返工作岗位并进行锻炼。据我们所知，这是第一例发表的关于在1型糖尿病或人类免疫缺陷病毒感染患者中使用艾塞那肽的病例报告。鉴于这一经验，艾塞那肽可能被证明是某些1型糖尿病患者有用的替代药物。
