Diagnostic and Therapeutic Uses of Intestinal Intubation

Intubation of the intestine is widely employed in the clinical management of patients. In this article are discussed some of the more important applications of this procedure in the diagnosis and treatment of intestinal, biliary and pancreatic diseases.     

Potential use of exenatide for the treatment of obesity

Introduction: Obesity is a major health threat in the Western world because of its high incidence and prevalence, and its association with metabolic and cardiovascular disease as well as cancer. The reduction of food intake in obese patients can be achieved only transiently (generally for no longer than 6 months), in the absence of concomitant pharmacological therapy. Only bariatric surgery provides a means to increase satiety and/or decrease nutrient absorption in obese patients, in the long term.

Areas covered: This article reviews the available pharmacological treatments for obesity as well as the pharmacology and mechanism of action of exenatide in obese type 2 diabetic patients.

Expert opinion: Exenatide is a potential new candidate treatment for obesity, possibly in combination with other hormones that increase satiety (leptin) and slow gastric emptying (amylin).     

Stabilizing effect of exenatide in a patient with C‐peptide‐negative diabetes mellitus

Background Exenatide is an incretin mimetic licensed for treatment of Type 2 diabetes poorly controlled despite maximally tolerated doses of oral therapy. Similar in structure to the natural incretin hormone glucagon‐like peptide 1 (GLP‐1), it helps restore underlying pathophysiological abnormalities. Case report We report the successful use of exenatide, combined with insulin, in a 66‐year‐old woman initially diagnosed with Type 2 diabetes in 1989 but now exhibiting a Type 1 phenotype. Diet, lifestyle advice and oral glucose‐lowering agents were commenced but persisting poor control necessitated insulin therapy in 2005. She later presented twice in diabetic ketoacidosis, suggesting conversion to a Type 1 phenotype (postprandial C‐peptide < 94 pmol/l). Despite differing insulin regimens, control remained poor with frequent hyperglycaemic and hypoglycaemic excursions, severely impairing quality of life. Whilst an inpatient in 2007 [glycated haemoglobin (HbA_1c) 10.2%, body mass index (BMI) 31.5 kg/m²] exenatide was commenced in an attempt to stabilize glycaemic control. Dramatic improvements were seen and continued. Eight months later, HbA_1c had fallen by 2% with an 8‐kg weight loss and 10‐unit reduction in daily insulin dose. Quality of life dramatically improved. C‐peptide remains undetectable. Conclusions This patient with features of both Type 1 and Type 2 diabetes benefited greatly from exenatide with insulin therapy. The improvement seen in glycaemic control could not be attributable to enhanced insulin secretion but could be as a result of a combination of the other incretin effects (postprandial glucagon suppression, delayed gastric emptying and weight loss secondary to increased satiety) all improving insulin sensitivity, reducing insulin dose and smoothing control.     

前列地尔联合艾塞那肽对2型糖尿病的疗效

目的探讨前列地尔联合艾塞那肽对2型糖尿病患者的疗效及对血清脂肪特异性丝氨酸蛋白内抑制剂(vaspin)和内抑素(NES)的影响。方法选取130例糖尿病患者,随机均分为观察组和对照组,每组65例。对照组给予艾塞那肽治疗,观察组给予艾塞那肽联合前列地尔治疗,治疗2周后观察2组患者的生化功能、血管功能、肾功能及血清Vaspin和NES水平。结果治疗前2组患者的生化功能、血管功能、肾功能及血清vaspin和NES水平比较差异无统计学意义,治疗后2组患者的空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1C)、体质量指数(BMI)、空腹C肽、餐后2 h C肽、三酰甘油(TG)和总胆固醇(TC)均显著下降,观察组下降更显著(P<0.05);治疗后2组患者的尿总蛋白、尿素氮(BUN)和血肌酐(SCr)均显著下降,观察组下降更显著(P<0.05);治疗后2组患者的收缩期血管峰值血流速度(PSV)和内膜中层厚度(IMT)均降低,且观察组下降更显著,狭窄率均升高,且观察组升高更显著(P<0.05);治疗后2组患者的血清vaspin和NES水平均显著升高,且观察组升高更显著(P<0.05);2组患者均未出现严重的不良反应。结论前列地尔联合艾塞那肽治疗2型糖尿病患者的效果较好,可有效控制血糖,显著升高血清vaspin、NES水平,改善患者的血管功能、肾功能,降低糖尿病的并发症发生率。     

Combined antidiabetic benefits of exenatide and dapagliflozin in diabetic mice

The combined glucose‐lowering effect of exenatide and dapagliflozin has not yet been studied. We investigated this combination (single‐dose or 4‐week dosing) in diabetic ob/ob mice. Vehicle‐corrected basal glucose showed greater reduction 1 h following exenatide + dapagliflozin than with exenatide or dapagliflozin alone, and stayed significantly lower for all groups versus vehicle over 3 h. During an oral glucose tolerance test, glucose excursion (30 min post‐dose) was significantly lower for exenatide + dapagliflozin versus exenatide or dapagliflozin, or vehicle. Exenatide + dapagliflozin and exenatide, but not dapagliflozin alone, reduced glucose excretion over 24 h versus vehicle. After dosing for 4 weeks, exenatide, dapagliflozin and exenatide + dapagliflozin similarly decreased haemoglobin A1c (HbA1c). Body weight was reduced only with exenatide or exenatide + dapagliflozin. The glomerular filtration rate was similar with exenatide, dapagliflozin and vehicle, and increased with exenatide + dapagliflozin. Optimized combinatorial dosing of these antidiabetic agents may provide additive glucose lowering in type 2 diabetes mellitus.     

Exenatide and sitagliptin are not associated with increased risk of acute renal failure: a retrospective claims analysis

Aim: This study evaluated whether the risk of acute renal failure (ARF) increases with exenatide and sitagliptin use. Methods: A retrospective cohort study of a large medical and pharmacy claims database was performed. Data for 4 91 539 patients were analysed. Cox proportional hazard models were used to compare the risk of ARF between diabetic and non‐diabetic subjects and between diabetic patients treated with exenatide, sitagliptin and control medications. Results: Adjusted Cox analyses showed diabetic subjects had a higher risk of ARF [HR 1.51, confidence interval (CI) 1.26–1.81, p < 0.001] than non‐diabetic controls. Compared with diabetic controls, neither exenatide (HR 0.77, CI 0.42–1.41, p = 0.40) nor sitagliptin (HR 1.17, CI 0.82–1.65, p = 0.39) increased the risk of ARF. Conclusion: Our study revealed an increased incidence of ARF in diabetic versus non‐diabetic patients but no association between use of exenatide or sitagliptin and ARF. Because of the limitations of this observational analysis, we cannot exclude the possibility of a very small increased risk.