Effect of treatment with exenatide and pioglitazone or basal-bolus insulin on diabetic neuropathy: a substudy of the Qatar Study



Ponirakis, Georgios, Abdul-Ghani, Muhammad A, Jayyousi, Amin, Almuhannadi, Hamad, Petropoulos, Ioannis N, Khan, Adnan, Gad, Hoda, Migahid, Osama, Megahed, Ayman, DeFronzo, Ralph
et al (show 6 more authors) (2020) Effect of treatment with exenatide and pioglitazone or basal-bolus insulin on diabetic neuropathy: a substudy of the Qatar Study. BMJ OPEN DIABETES RESEARCH & CARE, 8 (1). e001420-.

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Abstract

To assess the effect of exenatide and pioglitazone or basal-bolus insulin on diabetic peripheral neuropathy (DPN) in patients with poorly controlled type 2 diabetes (T2D). This is a substudy of the Qatar Study, an open-label, randomized controlled trial. 38 subjects with poorly controlled T2D were studied at baseline and 1-year follow-up and 18 control subjects were assessed at baseline only. A combination of exenatide (2 mg/week) and pioglitazone (30 mg/day) or glargine with aspart insulin were randomly assigned to patients to achieve an HbA1c <53 mmol/mol (<7%). DPN was assessed with corneal confocal microscopy (CCM), DN4, vibration perception and sudomotor function. Subjects with T2D had reduced corneal nerves, but other DPN measures were comparable with the control group. In the combination treatment arm (n=21), HbA1c decreased by 35.2 mmol/mol (3.8 %) (p<0.0001), body weight increased by 5.6 kg (p<0.0001), corneal nerve branch density increased (p<0.05), vibration perception worsened (p<0.05), and DN4 and sudomotor function showed no change. In the insulin treatment arm, HbA1c decreased by 28.7 mmol/mol (2.7 %) (p<0.0001), body weight increased by 4.6 kg (p<0.01), corneal nerve branch density and fiber length increased (p≤0.01), vibration perception improved (p<0.01), and DN4 and sudomotor function showed no change. There was no association between the change in CCM measures with change in HbA1c, weight or lipids. Treatment with exenatide and pioglitazone or basal-bolus insulin results in corneal nerve regeneration, but no change in neuropathic symptoms or sudomotor function over 1 year.

Item Type: Article
Uncontrolled Keywords: diabetic neuropathies, pioglitazone, Glucagon-Like Peptide 1, insulin glargine
Depositing User: Symplectic Admin
Date Deposited: 10 Feb 2021 11:00
Last Modified: 18 Jan 2023 23:00
DOI: 10.1136/bmjdrc-2020-001420
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3115431