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New Diabetes Treatments Show Promise

Inhaled Insulin, Lizard-Saliva Drug Offer New Options
By Salynn Boyles
WebMD Health News

Editor's Note: The FDA approved the inhaled insulin drug Exubera in 2006, but in October 2007 the drug company Pfizer said it was halting sales of the drug because of financial reasons.

Oct. 17, 2005 -- Two new diabetes treatments appear to control blood sugar in people with type 2 diabetes who do not achieve glucose control.

Newly published studies highlight the strengths and weaknesses of the two treatments -- a long awaited inhaled version of insulin and a novel injected drug derived from the saliva of the American Southwest's venomous lizard, the Gila monster.

"Both of these new therapies hold promise, but also uncertainty," American Diabetes Association president Robert Rizza, MD, tells WebMD. "They will increase the options for people with diabetes."

Improving Blood Sugar

People with type 2 diabetes progressively lose their ability to make and use their own insulin, an important hormone that the body needs to process sugar. The aim of treatment is to improve impaired blood sugar control to reduce the risk of diabetic complications.

This might be possible with diet and exercise alone early in the disease process, or a single medication to either enhance insulin secretion or help increase insulin sensitivity like the drug Metformin.

Later on, patients may be put on a combination of diabetes drugs, but eventually many need daily injections of insulin to control their blood sugar levels.

The two new treatments were tested in people with type 2 diabetes whose blood sugar could no longer be controlled with a combination of these pills for diabetes.

Both studies are published in the Oct. 18 issue of the Annals of Internal Medicine.

Weight Gain, Weight Loss

Unlike most other medications used to treat type 2 diabetes, including insulin, the new drug exenatide, made from the saliva of the Gila monster, does not cause weight gain. In fact, most patients lose some weight while taking the drug.

In a 26-week study comparing twice-daily injections of exenatide to long-acting, once-daily injections of insulin, patients on both treatments achieved similar blood sugar control. On average, those taking exenatide lost an average of 5 pounds, while those on insulin gained about 4.

But the exenatide group reported much higher rates of gastrointestinal side effects, with 57% reporting nausea, compared with 9% of the insulin patients, and 17% reported vomiting, compared with just fewer than 4% of those on insulin.

Overall, roughly 19% of the patients taking exenatide withdrew from the study because of side effects vs. just under 10% of those on insulin.

Patients receiving exenatide showed more improvement in blood glucose level after meals compared with the long-acting insulin (glargine), yet those taking long-acting insulin showed a greater reduction in fasting blood sugars compared with exenatide.

Both drugs similarly improved overall blood sugar control in people with type 2 diabetes with less than adequate control with a combination of oral diabetes medications, concludes the study.

The study was funded by exenatide manufacturer Eli Lilly and Co., a WebMD sponsor.

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