Exenatide : incretin therapy for patients with type 2 diabetes mellitus

Exenatide is the first in a novel class of drugs that mimics naturally occurring glucagon-like peptide 1. In patients with Type 2 diabetes mellitus (T2DM), control of both glycemia and bodyweight are important to minimize the risk of diabetes complications. Exenatide improves glycemic control through glucose-dependent insulin secretion, suppression of glucagon secretion, delaying gastric emptying and suppressing appetite. Exenatide therapy significantly reduced glycated hemoglobin (HbA1c) and fasting and postprandial plasma glucose when added to metformin and/or sulfonylureas, with an average weight loss of 2 kg. Furthermore, exenatide-treated patients sustained the reductions achieved in HbA1c at 12 weeks with a progressive reduction in bodyweight during 3-year follow-up. Exenatide is generally well tolerated; nausea is the most common side effect but significantly reduces over time and with gradual dose titration. Hypoglycemia at a rate greater than placebo only occurred in combination with sulfonylureas. Exenatide may enable patients with T2DM to improve glycemic control while reducing the risk of hypoglycemia and provoking weight loss.