Behind the headlines: One jab a week hope for diabetes

A weekly injection of a new long-acting form of exenatide could replace the need for twice-daily jabs in patients with type-2 diabetes, media reports suggest.

Exenatide is currently not licensed for use on its own in type-2 diabetes, and is only taken alongside first-line diabetes medications if they have failed to adequately control blood glucose levels.

At present, exenatide must be administered as a twice-daily subcutaneous injection into the thigh, abdomen or upper arm within the 60 minutes prior to breakfast and evening meals.

Researchers hope once-a-week jab will make glucose control easier


What is the research?
The findings, presented last week at the European Association for the Study of Diabetes conference in Rome, are based on a study of 259 patients with type-2 diabetes, funded by a pharmaceutical company.

Patients were randomly assigned to receive either 2mg of the standard twice-daily formulation of exenatide or 10 micrograms of the once-weekly exenatide for 30 weeks.

During the study period, the patients recorded their HbA1c levels and were monitored for any side-effects.

After 30 weeks, the researchers found patients taking the once-weekly exenatide reduced their HbA1c levels by 1.9 per cent compared with a reduction of 1.5 per cent for patients on the twice-daily formulation.

Overall, more patients on the once a week formulation (77 per cent) achieved the target HbA1c level of 7% compared with those on the twice daily formulation (61 per cent).

Patients taking once a week exenatide treatment lost an average of 4kg, 0.2kg more than patients on twice-daily exenatide.

The researchers suggest that the greater HbA1c reduction seen with the once a week treatment is due to the 'continuous exposure to exenatide resulting in a greater suppression of fasting glucagon, and a corresponding reduction in fasting glucose levels'.

What do the researchers say?
Lead researcher Dr Daniel Drucker, director of the diabetes centre at Mount Sinai Hospital in Toronto, said: 'Exenatide once-weekly resulted in significantly greater improvements in glycaemic control than exenatide given twice a day, with no increase in the risk of hypoglycaemia.

'A major advantage of this treatment is its ease of use as it only needs to be given once a week.'

The fact that the once-weekly form of the drug increased weight loss was a 'major secondary benefit', he said.

Dr Drucker added that the manufacturer of exenatide was now planning to file next year for approval for the use of the once-weekly drug.

What do other researchers say?
Dr Iain Frame, director of research at Diabetes UK, said: 'Any research that will help provide the evidence needed to reduce the number of injections required to achieve good glucose control is to be welcomed.

'There is not much detail provided in the report of this preliminary study but the results appear to be promising.'

The research will need to be extended and the results confirmed before we will see any change in current practice, added Dr Frame.

The Lancet Online 2008

Informing patients

  • Once-weekly injections with exenatide controlled blood glucose better than twice-daily injections.
  • Once-weekly injections were tolerated as well as the twice-daily jabs.
  • Exenatide should only be given when first-line medications have failed to control blood glucose levels.
  • Further long-term studies are needed to support these early findings.

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