A small proof-of-principle study in the European Journal of Endocrinology suggests that exenatide, a medication normally used to treat type 2 diabetes, could provide a quicker, less burdensome alternative to the traditional 72-hour fasting test for diagnosing endogenous hyperinsulinemic hypoglycemia (EHH).

The current gold-standard fasting test is time-consuming, costly, and uncomfortable for patients. In this randomized, placebo-controlled crossover trial, 14 patients with confirmed EHH received either intravenous exenatide or placebo during a monitored fast. Another 14 matched controls received exenatide unblinded.

Results showed that exenatide triggered diagnostic hypoglycemia in 42% of EHH patients within an average of 67 minutes, compared with none on placebo. The induced hypoglycemia occurred significantly faster and at lower glucose levels than with the standard test. Proinsulin levels also rose more in EHH patients than in controls after exenatide administration.

Exenatide shortened the time to hypoglycemia to just 1.38 hours, compared with 12 hours in the fasting test, and was well tolerated. Patients reported preferring the exenatide procedure over prolonged fasting.