Exenatide is an
incretin mimetic indicated for the treatment of
type 2 diabetes mellitus in combination with a sulfonylurea, a
thiazolidinedione,
metformin, or
metformin plus a sulfonylurea or
thiazolidinedione.
Exenatide lowers postprandial
blood glucose levels by stimulating
glucose-dependent insulin secretion, inhibiting
glucagon secretion, slowing gastric emptying, and increasing satiety.
Therapy with
exenatide often results in
weight loss, which further assists in decreasing
insulin resistance. This feature makes the
drug an attractive therapeutic option for obese patients. We report the successful
off-label use of
exenatide in an obese, 40-year-old man with
type 1 diabetes and human immunodeficiency virus (
HIV) infection who had gastrointestinal intolerance to
pramlintide. The patient had experienced a dramatic
weight gain secondary to his antiretroviral drugs. This
weight gain led to
insulin resistance and the development of
type 2 diabetes; thus he had characteristics of both types 1 and 2 diabetes, or double diabetes. Before the start of
exenatide therapy, he weighed 123 kg, had a body mass index of 42.3 kg/m(2), and had a suboptimal
hemoglobin A(1c) value of 8.7%. After 11 months of
therapy, the patient lost 24 kg (19.5% of his
body weight) and achieved a
hemoglobin A(1c) value of 7.3%. His basal
insulin requirement was reduced by 25%, and his use of
short-acting insulin before breakfast and before dinner was discontinued. In addition, the patient's quality of life substantially improved, as he was able to return to work and exercise after being nearly incapacitated by his weight. To our knowledge, this is the first published case report of the use of
exenatide in a patient with
type 1 diabetes mellitus or human immunodeficiency virus
infection. Given this experience,
exenatide may prove to be a useful alternative in selected patients with
type 1 diabetes.