Use of Exenatide in Patients With Type 2 Diabetes
- Robert Hood, MD,
- Virginia Valentine, CNS, BC-ADM, CDE,
- Susanna Mac, MD, PhD and
- William H Polonsky, PhD, CDE
- Address correspondence to: Virginia Valentine, CNS, BC-ADM, CDE Diabetes Network, Inc. 4108 Alcazar NE Albuquerque, NM 87109
Glucose homeostasis is regulated by a complex interplay of multiple hormones, including hormones from the pancreas (insulin, glucagon, and amylin) and the gut (glucagon-like peptide 1 [GLP-1] and glucose-dependent insulinotropic polypeptide). Most therapeutic options are focused on abnormal insulin secretion and signalling and do not address the role these other hormones play in glucoregulation and the diabetic state.
The inability to control glycemia over the long term utilizing single oral agents is reflected by the need to use various agents, alone or in combination, over time. In addition, the presence of associated side effects and clinical shortcomings of many therapies has prompted the search for new therapeutic agents that address the underlying dysregulation of multiple hormones found in people with diabetes. One of these agents, exenatide, mimics several of the actions of GLP-1 and is the first agent in a new class called incretin mimetics.
Exenatide was approved by the Food and Drug Administration in 2005 as an adjunctive therapy to metformin and/or sulfonylurea regimens for individuals with type 2 diabetes who have not achieved adequate glycemic control. Clinical trials indicate that subjects taking 10 μg of exenatide twice daily for 6 months had hemoglobin A1c (A1C) reductions of ∼1% and body weight reductions of ∼2 kg. After 1.5 years of exenatide treatment, reductions in A1C were sustained (1.1%), and body weight reductions were progressive (4.4 kg). In addition, exenatide treatment for 1.5 years resulted in improvements in some cardiovascular risk factors. For individuals with type 2 diabetes not achieving adequate glucose control with metformin and/or sulfonylureas, incretin mimetics such as exenatide may offer the opportunity for improved glycemic control with fewer clinical shortcomings than other available treatments.
Robert Hood, MD, is director of the Endocrine Clinic of S.E. Texas in Beaumont. Virginia Valentine, CNS, BC-ADM, CDE, is chief executive officer at Diabetes Network, Inc., in Albuquerque, N.M. Susanna Mac, MD, PhD, is a medical writer at Amylin Pharmaceuticals, in San Diego, Calif. William H. Polonsky, PhD, CDE, is president of the Behavioral Diabetes Institute and an associate clinical professor in psychiatry at the University of California, San Diego in La Jolla.
Note of disclosure: Dr. Hood has received honoraria for speaking engagements and has served on an advisory board for Amylin Pharmaceuticals and Eli Lilly and Co. Ms. Valentine has served on an advisory board and received honoraria from Amylin and Eli Lilly. Dr. Mac is an employee of and stock shareholder in Amylin. Dr. Polonsky has served as a paid consultant and advisory board member for Amylin. These companies have collaborated on the manufacturing and marketing of exenatide.
- American Diabetes Association