Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2020; 11(12): 654-665
Published online Dec 15, 2020. doi: 10.4239/wjd.v11.i12.654
Exenatide once weekly combined with metformin reduced glycemic variability in type 2 diabetes by using flash glucose monitoring system
Yang Li, Min-Min Han, Qiong He, Zi-Ang Liu, Dong Liang, Jing-Tian Hou, Yi Zhang, Yun-Feng Liu
Yang Li, Min-Min Han, Qiong He, Dong Liang, Jing-Tian Hou, Yun-Feng Liu, Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Zi-Ang Liu, Department of First Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Yi Zhang, Department of Pharmacology, Basic Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: Liu YF and Zhang Y designed the study and revised the manuscript; Li Y and Han MM drafted the initial manuscript; Li Y, Han MM, and He Q analyzed and interpreted the data; Liu ZA, Liang D, Hou JT, Li Y, Han MM, and He Q conducted the study and collected the data. All authors read and approved the final manuscript for publication.
Supported by National Natural Science Foundation of China, No. 81770776 and No. 81973378; Cultivate Scientific Research Excellence Programs of Higher Education Institutions in Shanxi, No. 2019KJ022; and Special Project for Transformation and Guidance of Scientific and Technological Achievements in Shanxi Province, No. 201804D131044.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the First Hospital of Shanxi Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Feng Liu, PhD, Chief Physician, Professor, Department of Endocrinology, First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Yingze District, Taiyuan 030001, Shanxi Province, China. nectarliu@163.com
Received: June 27, 2020
Peer-review started: June 27, 2020
First decision: September 18, 2020
Revised: October 9, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 15, 2020
Processing time: 168 Days and 14.7 Hours
ARTICLE HIGHLIGHTS
Research background

Multiple studies demonstrate that fluctuating blood glucose level produces greater damage compared with sustained hyperglycemia. Flash glucose monitoring system (FGMS) is an effective method in documenting blood glucose variability, contributing to better glucose management and reduced hypoglycemic event occurrence.

Research motivation

A dynamic blood glucose monitoring system was used to observe the blood glucose characteristics of type 2 diabetes patients during the use of exenatide once weekly (EXQW) combined with metformin.

Research objectives

As the aims of this study, the clinical and therapeutic effects of combined EXQW and metformin treatment in type 2 diabetes patients were evaluated by using FGMS and metabolic indicators. Based on the FGMS data, we analyzed and compared the glycemic variability-related indices, and hypoglycemic incidence between baseline and end points.

Research methods

This study is a pre-post study involving the same group of patients. Patients wore FGMS twice during the screening period (oral metformin monotherapy) and the experimental period (EXQW combined with metformin), respectively, and the changes of blood glucose characteristics and related metabolic indexes at baseline and endpoint were observed.

Research results

After 12 wk of combined treatment, hyperglycemia was controlled, especially fasting blood glucose, and postprandial blood glucose levels were also reduced. The percentage of time in range (3.9-7.8 mmol/L) increased and the percentage of time out of range decreased. The fluctuation of blood glucose was more stable than baseline, and there were statistically significant differences in standard deviation of blood glucose, mean amplitude of glycemic excursion, mean of daily difference, area under the curve of IQR, and area under the curve of IDR. After treatment of EXQW combined with metformin, the duration of hypoglycemia (< 3.9 mmol/L) increased, mainly at night, but the duration of severe hypoglycemia (< 3.0 mmol/L) did not increase. In addition, metabolic indexes such as body weight and waist circumference were improved.

Research conclusions

The combination of EXQW and metformin can effectively control hyperglycemia, reduce glycemic variability, and improve metabolic indexes. By analyzing FGMS data during different time periods, EXQW was found to significantly improve fasting and postprandial glucose without increasing the incidence of severe hypoglycemia (< 3.0 mmol/L) events, but still with an increased risk of nocturnal hypoglycemia.

Research perspectives

This study has its limitations, and we expect that a multi-center, large-sample study should be carried out.