Assessment of Exenatide Extended-Release for Maintenance of Diabetic Remission in Cats

Background: Insulin-treated diabetic cats frequently achieve transient remission. The glucagon-like peptide-1 receptor agonist, exenatide extended-release (exenatide-ER), preserves β cell function in people with type 2 diabetes mellitus (DM). Objectives: Investigate the effect of exenatide-ER on the duration of diabetic remission in cats. Animals: Twenty-two client-owned cats with recent diabetic remissions. Methods: Placebo-controlled, single-blinded study. Cats were assigned randomly to receive exenatide-ER (0.13 mg/kg) or saline injection SC, once monthly for 2 years or until DM relapsed. Cats were fed low-carbohydrate diets; weight control was actively supervised. Paired t-tests and Mann–Whitney were used to compare pre- versus post-study characteristics within groups and between group outcomes, respectively. Results: Treatment groups (placebo, N = 10; exenatide-ER, N = 12) were similar in age, sex, and body weight upon inclusion. Thirteen cats completed the 2-year study without diabetic relapse. Nine cats (placebo, n = 4; exenatide-ER, n = 5) exited prematurely. Three of these exited because of DM relapse (placebo: N = 1, day 212; exenatide-ER: N = 2, days 553 and 558). There was no difference in remission duration between treatments (placebo: 669 [121–721]; exenatide-ER: 662 [28–735] days, p = 0.9). Median body weight decreased in both groups at study exit (placebo: −0.6 kg [−1.3 to +0.3], p = 0.03; exenatide-ER: −0.2 kg [−1.2 to +0.5], p = 0.02). Hemoglobin A1c remained unchanged on exenatide-ER (−0.05% [−6.9 to +2.1]) but increased on placebo (+2.3% [−1.7 to +4.4]; p = 0.03). Conclusions and Clinical Importance: Exenatide-ER contributed to the maintenance of glycemic control as reflected by hemoglobin A1c but did not affect remission duration. Management might have contributed to the extended remission duration.