A new class of drugs called incretin mimetics is offering hope to patients with type-2 (non-insulin-dependent) diabetes who have not been able to control their blood glucose levels after taking common oral regimens. Patients in phase III trials who received the investigational drug exenatide (synthetic extendin-4, Amylin/Eli Lilly) had lower blood glucose levels as well as improvements in markers of beta-cell function—and they lost weight to boot.
Researchers presented their findings from three studies at the 64th Annual Scientific Sessions of the American Diabetes Association.
In one study of 336 patients for whom maximal doses of metformin were not working, glycosylated hemoglobin (HbA1C) was significantly reduced from baseline measures with exenatide compared with placebo. At 30 weeks, 46% of those patients taking 10 mcg and 32% of those taking 5 mcg had levels below 7%, compared with 13% of patients taking a placebo. Side effects were mild or moderate, and usually gastrointestinal, such as nausea.
A second study included 733 patients whose blood glucose levels were not controlled with generic metformin therapy and a sulfonylurea. Again, exenatide reduced HbA1C from baseline, by about 8.5%, and also brought about weight loss.
Patients from both of these studies who participated in a 52-week open-label extension study received exenatide 10 mcg twice daily. Among 51 patients taking exenatide plus metformin, the average reduction in HbA1C was 1.1%; these patients also lost an average of 9.9 pounds. Among 77 patients who received extended treatment with exenatide and metformin/sulfonylurea canadian, hemoglobin A1C levels declined by 1.0% and the average weight loss was 7.3 pounds.
Incretin mimetics are derived from hormone research. Exenatide is a synthetic version of exendin-4, a hormone found in the saliva of the Gila monster (a lizard). The lizard eats only four times a year. Its pancreas shuts down the remainder of the time, and exendin-4 is secreted to reactivate the pancreas.