Article Figures & Data
Figures
- Figure 1.
Steps for mixing exenatide extended release.
Tables
- Table 1. Food and Drug Administration–Approved Incretins and Clinical Effects as Monotherapy6–11
GLP-1 Agonists or Analogs DPP-4 Inhibitors Exenatide ER (Bydureon) Exenatide (Byetta) Liraglutide (Victoza) Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Route SQ SQ SQ Oral Oral Oral Dosing frequency Once a week Twice a day Daily Daily Daily Daily Change in A1c, % −1.6 −0.9 −1.1 −0.5 −0.5 −0.4 Change in weight, kg −2.0 −2.5 −1.9 −1.5 −1.1 −1.0 Hypoglycemia ± ± ± — — — Adverse GI effects + + + + + — — — Approximate monthly cost of therapy ($),12 370 360 520 260 260 280 ER, extended release; GLP, glucagon-like peptide; DPP, dipeptidyl peptidase; GI, gastrointestinal; SQ, subcutaneously.
Considerations Comments Objective criteria Diagnosis of type 2 diabetes mellitus FDA indication Triglycerides <500 mg/dL Reduce risk for pancreatitis No history of or current issues with alcoholism Reduce risk for pancreatitis Amylase WNL Reduce risk for pancreatitis Lipase WNL Reduce risk for pancreatitis No history of current or recurrent pancreatitis Reduce risk for pancreatitis No history of current or recurrent gallstones Reduce risk for pancreatitis Normal or mild renal impairment (CrCL >60 mL/min) Caution with CrCL 30–60 mL/min; avoid in those with CrCL <30 mL/min or ESRD Normal hepatic function Caution in acute or chronic hepatic impairment; effects are unknown Others Concurrently taking a sulfonylurea agent Halve the sulfonylurea agent dose to reduce risk of hypoglycemia; educate patient on signs/symptoms of hypoglycemia and appropriate treatment Dexterity Drug requires self-reconstitution and injection Digit manipulation issues: arthritis, rheumatoid arthritis Drug requires self-reconstitution and injection Adherence Remembering weekly drug administration Tolerability Consider using in patients who have tolerated exenatide twice daily CrCL, creatinine clearance; FDA, U.S. Food and Drug Administration; ESRD, end-stage renal disease; WNL, within normal limits.
