Endocrine Abstracts

Objectives: The aim of the audit was to determine how our current clinical practice differs from that of the national standard set out in the UK by NICE guidance CG87 in regards to the use of exenatide.

Material and methods: We measured weight and HbA1c at baseline and then again at 6 months from the date exenatide was started. The UK NICE guidelines recommends exenatide should only be considered in patients with a BMI≥35.0 kg/m² with a HbA1c≥7.5% (adjusted for ethnicity). We analysed data from all patients who had been followed up by the Diabetes Nurse Specialist for at least 6 months from initiating exenatide therapy.

Results: Complete data was available for 27 patients. 59% of patients were started on exenatide in a non-EMEA licensed combination with other diabetic drugs. 85% of patients were commenced on exenatide with a HbA1c≥7.5%, but only 62% of patients had a BMI≥35.0 kg/m² (adjusted for ethnicity). At 6 month follow up only 22% of patients had both a reduction of at least 1% in HbA1c and a weight loss of at least 3% of initial body weight.

Conclusions: According to UK NICE guidance, the target to continue exenatide beyond 6 months will only apply to 22% of our patients (~1 in 5). If targets were to be relaxed, so that exenatide could be continued in patients who achieved EITHER a reduction of at least 1% in HbA1c OR a weight loss of at least 3% of initial body weight then 65% of our patients would have been able to continue exenatide therapy beyond 6 months. These ‘relaxed’ targets might decrease patient dissatisfaction from discontinuing therapy and provide more freedom to clinicians in order to continue exenatide therapy.