From the Guidelines
The patient's diabetes management should be prioritized with an alternative medication to Byetta, considering her glycemic control, comorbidities, and reason for discontinuation, with options including semaglutide (Ozempic) or dulaglutide (Trulicity) as per the latest guidelines from the American Diabetes Association 1. The patient presents with a history of diabetes, reporting that Byetta (exenatide) has been discontinued and is seeking an alternative medication. She also describes bilateral lower extremity swelling that has persisted for several years, with the left leg currently more affected than the right. The patient specifically denies any associated pain, shortness of breath, hemoptysis, or calf pain/redness. This presentation suggests chronic venous insufficiency rather than an acute deep vein thrombosis, given the longstanding nature of the swelling and absence of pain or redness. Some key points to consider in her management include:
- The asymmetric worsening of the left leg swelling warrants further evaluation to rule out other potential causes.
- Regarding diabetes management, alternative medication options to replace Byetta could include another GLP-1 receptor agonist such as semaglutide (Ozempic) or dulaglutide (Trulicity), which have demonstrated evidence of cardiovascular benefit in large CV outcome trials 1.
- The bilateral leg swelling should be addressed concurrently, with potential interventions including compression stockings, leg elevation, and further diagnostic workup to determine the underlying cause.
- It is essential to consider the patient's kidney function when selecting an alternative medication, as some medications may require dose adjustments or are contraindicated in certain stages of chronic kidney disease, as outlined in the consensus report by the American Diabetes Association and Kidney Disease: Improving Global Outcomes 1.
- The latest guidelines from the American Diabetes Association provide a comprehensive approach to diabetes management, including pharmacologic approaches to glycemic treatment, which should be considered in the patient's treatment plan 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
History of Present Illness (HPI)
The patient reports that Byetta (exenatide), a GLP-1 receptor agonist, has been discontinued 2, 3, 4. She is seeking an alternative diabetes medication. The patient has been experiencing ongoing bilateral swelling for several years, with the left leg swelling more than the right. However, she denies experiencing pain, shortness of breath, or coughing up blood. She also denies any pain or redness in the calf area.
Current Symptoms
- Bilateral swelling for several years, with the left leg swelling more than the right
- No pain or shortness of breath
- No coughing up blood
- No pain or redness in the calf area
Medication History
- Byetta (exenatide) was discontinued
- Seeking an alternative diabetes medication
Relevant Studies
- GLP-1 receptor agonists, such as exenatide, have been shown to be effective in reducing HbA1c levels and lowering postprandial blood glucose levels 2, 3, 4
- SGLT2 inhibitors and GLP-1 receptor agonists have been shown to reduce the risk of major adverse cardiovascular events (MACE) compared to sulfonylureas and DPP-4 inhibitors 5
- Metformin is commonly continued after insulin initiation, and other non-insulin diabetes medications, such as GLP-1 receptor agonists, may also be continued 6