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

<h4>Introduction</h4>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).<h4>Research design and methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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: 11 Feb 2023 02:56
DOI: 10.1136/bmjdrc-2020-001420
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3115431