A non-selected referred group (52) of country living, type 2 diabetics were commenced on exenatide. The 2 year response in 20 ,(M13.F,7.) were audited.

Mean age 60.5 years, weight 125kg (R102-152), HbA1c 9.3%, duration of diabetes 13.8yrs. Insulin users 16.

Severe co-morbidities were frequent. Obesity 100%, (BMI >35) Vascular disease 90%, Hypertension 45%, Sleep apnoea,55%, Hypercholesterolemia 60%,, Psychological 25%.

Methods. Assessment and biochemistry at all visits, reviewed at 3 months, then 6 month intervals for 2 years.

Treatment. Exenatide commenced 10ug dose for 2 weeks and then 10ug twice daily. Metformin continued (16). Sulfonylureas ceased (6)

Pre exenatide insulin mean daily dose (114 units) reduced stepwise over 4 weeks and ceased. If blood glucose values increased insulin was restarted at quarter original dose.

Results. (Mean ± SD.) Weight, initial 125 ± 19.4kg, 3 months 117 ± 21.1kg, 12 months 114.7 ± 19.3, 24 months 112 ± 22.3. 18 lost weight except 2 who increased by 15kgs.

The HbA1c initial 9.3% ± 1.2 (R 7.9-12), 3months 8.3% ± 1.3, 12 months 8.2% ± 1.4, 24 months 8.0 ± 1.5. At commencement no one had an HbA1c < 7%. After 2 years 7 were 7% or less.

Insulin was restarted in 6. Oral hypoglycaemics were added in 6.

There was no significant change in creatinine, lipids liver function, or blood pressure.

Side effects. Exenatide caused nausea in 7 but not discontinued.

Conclusions. The use of exenatide resulted in a significant weight loss of 13kg, HbA1c decreased by 1.3%, insulin ceased in 10, reduced daily insulin dose to 30 units, and an overall sense of satisfaction at the weight loss and improved diabetic control which had not previously occurred.

No financial interests declared.