Times of India
01 July 2010
By Rupali Mukherjee
Mumbai, India

Long–suffering diabetics can find daily insulin jabs painful and cumbersome, so a new, once–a–week shot may soon revolutionize treatment for thousands suffering from the dreaded disease.

Researchers have found that a long–acting medication, exenatide, if injected once a week, improves blood sugar control and induces weight loss in type 2 diabetics. The study, conducted at VU University Medical Centre, Amsterdam, has been reported in the latest issue of the medical journal ‘Lancet’, and will be discussed at the ongoing American Diabetes Association’s session at Orlando.

A cross–section of doctors that TOI spoke to pointed out that newer treatments are constantly needed for curing diabetes as first–line drugs fail to have the desired impact over a period of time, or may have serious side–effects. New drugs that are convenient to administer, provide effective glycaemic control and do not cause weight gain are constantly needed.

Exenatide is good news for diabetics who have uncontrolled sugars despite maximum doses of conventional anti–diabetic drugs. Those who are obese or prone to recurrent low sugars (hypoglycemia) may be particularly benefited, doctors pointed out. The study says that the new formulation of exenatide may be better for patients than the once–a–day insulin shot (glargine), as the latter leads to weight gain.

In this 26–week randomized study, results were compared of exenatide and insulin glargine in adults with type 2 diabetes who had inadequate blood sugar control despite the use of first–line anti–diabetic drugs for three months or longer (these first–line drugs were either metformin or metformin plus sulphonylurea). In the study, professor Michaela Diamant and colleagues tested the new formulation of exenatide on 456 patients (233 with once–a–week exenatide and 223 insulin glargine).

Two doctors — Dr Anoop Misra (Fortis Hospital, Delhi) and Dr Shashank Joshi (Lilavati and Bhatia Hospital, Mumbai) — who reviewed the study say that exenatide for type 2 diabetes is more convenient and induces better blood sugar control, and more weight loss than second–line treatment of the daily insulin glargine. (Insulin glargine, which has to be injected daily, led to weight gain of 1.4kg per patient.)

Dr Misra and Dr Joshi agree that exenatide could be used in patients ‘‘with obesity and those in whom hypoglycaemia is a clinical concern’’, adding: ‘‘Currently, there is more promise, few disadvantages, and some unknowns about treatment with long–acting exenatide for diabetes. While exenatide has been found to improve blood glucose control and induce weight loss in other studies, those studies had used the twice–daily formulation (exenatide).’’

The study consisted of mostly white participants, and would be strengthened by replication in other populations, experts noted.

The drug, if cleared, will be commercially available in the US by the year–end, and later in the country.