Can exenatide affect kidney function in patients with type 2 diabetes mellitus that are overweight or obese?

This study investigated the effect of exenatide (EXE; Byetta) on kidney function, obesity and glucose control in overweight or obese patients with type 2 diabetes (T2D). The data showed that EXE could assist in improving kidney function, glucose control, and inflammation after 24 weeks of treatment.

Diabetic nephropathy (DN) is a kidney-related complication of T2D that is linked to overweight or obesity. An increased level of albumin (the main blood protein) in the urine (microalbuminuria) is a reliable, consistent indicator of early-stage DN. Albumin is normally found in the blood as well-functioning kidneys prevent its entry into the urine.

EXE is a glucagon-like peptide 1 (GLP-1) drug shown to improve blood glucose control and bodyweight reduction. Once-weekly administered EXE has also been shown to be more effective than insulin glargine (GLAR; Lantus) at reducing HbA1c levels (average blood glucose over 2 to 3 months). Additionally, twice-weekly administered EXE does not change kidney function or albuminuria compared to GLAR treatment. There is a need to assess whether the protective effects of EXE on the kidneys are linked to weight loss in patients with T2D that are overweight or obese.

This study included 159 patients with T2D who were overweight or obese. Patients were assigned to an EXE or a GLAR treatment group. 79 patients initially received EXE at 5 μg, twice-daily for 4 weeks through injection, 15 minutes before breakfast and dinner. This dose was increased up to 10 μg, twice-daily for the remaining period. 80 patients received GLAR, once-daily. The urinary albumin concentration (UAC), glucose measurements, lipid measurements, and inflammatory biomarkers were evaluated for 24 weeks.

At weeks 12 and 24, patients treated with EXE had significantly lower UAC, and improved glucose measurements such as fasting glucose, HbA1c, and insulin levels.

At week 24, triglycerides (TG; blood fat), high-density lipoprotein cholesterol (HDL-c or "good" cholesterol), and C-reactive protein (CRP; an inflammatory marker) were significantly improved in the EXE treatment group. Tumor necrosis factor-α (TNF-α; an inflammatory marker) was significantly improved at weeks 12 and 24 in the EXE treatment group. 

The study suggests that EXE is safe and effective and could improve UAC, glycemic levels, and inflammation in patients with T2D who were overweight or obese.

The study period was short in duration and some patients were lost to follow-up.