Lilly and Amylin’s Byetta (exenatide) is as effective as twice-daily insulin in

type 2 diabetes patients who can no longer be managed on oral anti-diabetic drugs. Unlike insulin, however, Byetta does not need regular dose adjustment and is associated with significant weight reduction. These results, reported at the 42nd Annual Meeting of the European Association for the Study of Diabetes in Copenhagen, indicate that Byetta could be a potential alternative to insulin in type 2 diabetes patients treated with metformin and/or a sulphonylurea.

Byetta is an incretin mimetic, a new class of type 2 diabetes treatments that ‘mimics’ the effects of naturally occurring gut hormones (incretins) and so helps the body make more of its own insulin. At present, Byetta must be injected twice daily, but a long-acting, weekly-dosed formulation is in development. In a small study also reported in Copenhagen, once-weekly Byetta was not only well tolerated, but also improved blood glucose control and reduced body weight in patients with type 2 diabetes.

If these benefits are borne out in larger studies, once-weekly Byetta could be a very attractive option in type 2 diabetes patients whose blood glucose cannot be controlled on oral treatment. Although insulin is effective in these patients, it causes weight gain – a particular problem in people with type 2 diabetes, most of whom are overweight or obese.

The efficacy and tolerability of the once-weekly formulation needs to be

demonstrated in larger studies, but these results are undoubtedly a boost for Byetta, especially now that recent supply problems have been resolved. By Sue Lyon