Post-Bariatric Hypoglycemia Effectively Treated by Subcutaneous Exendin

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The researchers observed an exposure-response relationship, but all doses effectively prevented hyperinsulinemic hypoglycemia and improved associated symptoms.
The researchers observed an exposure-response relationship, but all doses effectively prevented hyperinsulinemic hypoglycemia and improved associated symptoms.

HealthDay News — Subcutaneous exendin (SC Ex-9) appears to be safe and effective in treating post-bariatric hypoglycemia (PBH), according to a study published in Diabetes, Obesity and Metabolism.

Colleen M. Craig, MD, from the Stanford University School of Medicine in California, and colleagues conducted the first in-human subcutaneous administration of Ex-9 in 9 female patients with PBH following Roux-en-Y gastric bypass. First, a single participant underwent equimolar low-dose IV vs subcutaneous Ex-9 administration. Then, 8 participants were administered single ascending doses of SC Ex-9 during oral glucose tolerance testing.

The researchers observed an exposure-response relationship, but all doses effectively prevented hyperinsulinemic hypoglycemia and improved associated symptoms. The postprandial glucose nadir was increased by 66%, peak insulin was reduced by 57%, and neuroglycopenic symptoms were reduced by 80%, on average. No treatment-related adverse events were reported.

"SC Ex-9 appears to represent a safe, effective, and targeted therapeutic approach for treatment of PBH," the authors write. "Further investigation involving multiple doses with chronic dosing is warranted."

Several authors disclosed financial ties to the pharmaceutical industry.

Reference

Craig CM, Liu LF, Nguyen T, et al. Efficacy and pharmacokinetics of subcutaneous exendin (9-39) in patients with post bariatric hypoglycaemia [published online August 4, 2017]. Diabetes Obes Metab.  doi: 10.1111/dom.13078.

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