Once a Week Drug Shows Promise for Type 2 Diabetes

The diabetic drug exenatide (Byeta), injected twice a day, has been reformulated so it can be taken once a week. Two separate studies show promise for improved control of blood sugar, blood pressure reduction, and weight loss in diabetic patients with weekly dosing. John B. Buse, MD, PhD, CDE, president, Medicine & Science, of the American Diabetes Association presented his findings at the Late Breaking Clinical Studies section of the American Diabetes Association 68th Scientific Sessions.

Exenatide mimics the natural effect of hormones that naturally regulate blood glucose levels through delays in gastric emptying, inhibition of glucagon release (a hormone responsible for increasing blood sugar levels), and stimulation of insulin-dependent glucose release.

The first study enlisted 295 patients with type 2 diabetes, providing one group with weekly dosing, and the other with twice-daily treatment of exenatide. HgA1C level, a test that measures diabetic blood sugar control over a two to three month period, was decreased more in the patients who received exenatide once a week. Improvements in fasting blood sugar were seen, and the patients in the weekly dosing group lost an average of 8 pounds.

Further benefit was seen in the patients who enrolled in an extended 22-week study. Those who had received the weekly dosing continued to improve, and those who were switched from twice a day medication showed the same improvements seen in the first study. Those who received weekly dosing for the entire 52 weeks had a 2% reduction in HgA1C levels and a 47mg/dL blood sugar reduction. Weight loss was similar for both groups. Even more good news was found - everyone experience better blood pressure control after 52 weeks. Systolic and diastolic blood pressure was lowered by 4-5mm/Hg and 2.2mm/Hg respectively.

What’s New in Exenatide?

According to Dr. Buse, they’ve combined exenatide with “the same stuff that's used to make resorbable sutures …This resorbable suture material apparently forms these beadlike things that have drug in the matrix, and then the bead sort of breaks apart. It's reabsorbed and the drug is released." The result is medication release over weeks or months.

What’s the down Side?

A comment to Medscape Diabetes & Endocrinology from Anne L. Peters, MD, CD, director of the Clinical Diabetes Programs at the University of Southern California, and professor of clinical medicine at the university's Keck School of Medicine, emhasizes awareness that switching to weekly dosing of exenatide will produce a more rapid rise and fall of blood sugar levels that “Patients and providers will need to be aware of when transitioning from one preparation to the other."

The only reported side effect was nausea, in 7% of the patients. According to Dr. Buse, ”One of the nice things about this long-acting formulation is that the levels of exenatide, as the capsular material dissolves, increase relatively slowly, so in general, it is better tolerated than the exenatide twice a day. There are some patients who have nausea, but it tends not to be severe nausea or consistent nausea, all day, every day."

Successful treatment of type 2 diabetes is always welcome news. The demands of taking medications regularly can interfere with lifestyle, and can be easily forgotten when taken daily or throughout the day. Diabetics who experience proper blood sugar control risk less chance of diabetic complications, such as kidney disease, retinopathy, and painful nerve damage (neuropathy). Better control of blood sugar ultimately means fewer hospitalizations, improved compliance with medication, and decreased financial burden. Ongoing news about the benefits of weekly diabetic treatment with exenatide is certainly worth following for anyone with type 2 diabetes.

American Diabetes Association 68th Scientific Sessions: Late Breaking Clinical Studies. Presented June 9, 2008.