Exenatide: A New Type of Drug to Treat Type 2 Diabetes

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Effects of exenatide (exendin-4) on glycemic control over 30 weeks in patients with type 2 diabetes treated with metformin and a sulfonylurea, by D.M. Kendall and colleagues. Diabetes Care 28:1083–1091, 2005.

Effects of exenatide (exendin-4) on glycemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes, by R.A. DeFronzo and colleagues. Diabetes Care 28:1092–1100, 2005.

What is the problem and what is known about it so far?

When diet and exercise aren't enough to control type 2 diabetes, patients can try certain oral drugs to lower their blood glucose. Often though, patients who take diabetes drugs are aren't able to lower their blood glucose to a healthy level, even if they take more than one type of drug.

Why did the researchers do these particular studies?

Some patients aren't able to get their blood glucose to a healthy level by taking oral drugs to treat type 2 diabetes. The researchers wanted to see if adding another drug, exenatide, would help these patients.

Exenatide triggers insulin production after a meal, but only when blood glucose is high. Like insulin, it has to be injected.

Who was studied?

One study looked at 733 adults with type 2 diabetes who were taking both metformin and a sulfonylurea to treat high blood glucose, while another study looked at 272 patients who were taking only metformin.

Metformin and sulfonylureas are two of the most common types of diabetes drugs. Sulfonylureas spur the pancreas to produce more insulin, while metformin lowers the amount of glucose produced by the liver .

How were the studies done?

In one study, the patients were taking both metformin and a sulfonylurea. Some patients were given either a small or large dose of exenatide in addition to their metformin and sulfonylurea. Other patients were given a placebo, or a pill that has no effect, with their metformin and sulfonylurea.

The patients in the other study were taking metformin only. Once again, some patients were given either a small or large dose of exenatide in addition to their metformin, while other patients were given a placebo.

Both studies lasted for 30 weeks. The researchers measured the patients' blood glucose levels and weight.

What did the researchers find?

Patients who took exenatide were more likely to get their blood glucose to a healthy level. They also lost more weight than the patients who took a placebo.

The most common side effect of exenatide was mild nausea.

The researchers found that patients who take exenatide with a sulfonylurea may need to lower their dose of sulfonylurea to avoid hypoglycemia, or blood glucose levels that are too low.

What were the limitations of the studies?

In these studies, there was no way to compare the effects of exenatide with the effects of other types of drugs to treat high blood glucose.

What are the implications of the studies?

Exenatide is a new option for patients who aren't able to lower their blood glucose by taking other diabetes drugs.

The Food and Drug Administration recently approved the use of exenatide with other diabetes drugs, but said more studies are needed to see whether exenatide alone can be used as a treatment for type 2 diabetes.

FOR MORE INFORMATION

First of New Class of Drugs for Diabetes Successful

A Gut Response: The Next Generation of Type 2 Drugs

Other Diabetes Medications