NICE guidance - exenatide

NICE guidance states that a GLP-1 mimetic (incretin mimetic) (exenatide) is a therapeutic option in type 2 diabetes.

In the latest guidance (2) NICE state that:

If triple therapy (metformin tolerant treatment arm) is not effective, not tolerated or contraindicated, consider combination therapy with metformin, an SU and a GLP-1 mimeticc for adults with type 2 diabetes who:

• have a BMI of 35 kg/m2 or higher (adjust accordingly for people from black, Asian and other minority ethnic groups) and specific psychological or other medical problems associated with obesity or
• have a BMI lower than 35 kg/m2, and for whom insulin therapy would have significant occupational implications, or weight loss would benefit other significant obesity-related comorbidities

Continuation of GLP-1

• Only continue GLP-1 mimetic therapy if the person with type 2 diabetes has had a beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months)
  
  

For detailed guidance then consult the full guideline (2).

Reference:

• 1. NICE (May 2009). Type 2 diabetes: newer agents Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes
• 2. NICE (December 2015). Type 2 diabetes in adults: management