USC Westside Center for Diabetes | November 2003 Newsletter

INSIDE THIS ISSUE


		USC Comes to the Westside: Event at the Regency Club

		Drugs: A potential new way to improve glucose control has some slithery beginnings.

		Welcome: Meet the center's newest endocrinologist.

Points of Interest


		New Support Group

		April Diabetes Updates

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	New Drugs on the Horizon While a future without diabetes would be preferable to all (and a goal that many researchers are working on), the near future must depend on enhancements in drug therapy to aid in reducing the complications associated with diabetes and to help maintain target blood glucose levels. Exenatide is one of today’s many new agents under development. Exenatide is the first in a new class of drugs that may be beneficial in treatment of type 2 diabetes. Exenatide is initially under development by a company called Amylin Pharmaceuticals to improve glucose control in patients with type 2 diabetes who are not using insulin and not able to achieve target blood glucose levels with diet, exercise and oral medications. This drug is based on a human hormone called GLP-1, which is made in the gut. GLP-1 has a very short lifespan of action, which makes it difficult to use as therapy. Exenatide is a similar compound to GLP-1 but has a much longer duration of action. Interestingly, exenatide is actually derived from the poisonous saliva of a huge lizard called the gila monster. (You heard it here first, folks!) Exenatide is a small-butpotent amino acid chain that exhibits several anti-diabetic, or glucose-lowering, actions. Clinical trials have shown that this compound can stimulate insulin secretion when blood glucose concentrations are elevated, but not during periods of low blood glucose concentration. Thus, it appears to be a compound that is sensitive to circulating glucose levels. Other studies have shown that exenatide slows stomach emptying. This may help to modulate the entry of ingested nutrients from food into the bloodstream, and thereby help to control blood glucose levels after eating. In addition, preliminary data indicate that exenatide may cause a sensation of fullness early on and reduce food consumption — leading to reduced body weight. As a result of the combination of these actions, exenatide administration can lower blood glucose concentrations in patients with type 2 diabetes, resulting in a reduction of HbA1c levels. A number of clinical trials today are looking at the use of exenatide in different populations of type 2 diabetes. One trial is evaluating exenatide in people with type 2 diabetes who are not achieving target blood-glucose concentrations using metformin alone. Another trial of about 400 patients uses a similar protocol and is evaluating the effects of exenatide on patients who are not achieving target blood-glucose concentrations using sulfonylureas alone. A third clinical trial of 800 patients is evaluating exenatide’s effects on patients who are currently not achieving target bloodglucose concentrations using a combination of metformin and sulfonylureas. In these clinical trials, exenatide appears to be well-tolerated. Most adverse events reported were considealt mild or moderate in intensity. These events included nausea (the most common adverse event) and vomiting (to a much lesser extent). Patients who gradually increased their dose of exenatide had a clinically meaningful reduction in the incidence of nausea compared to patients who did not receive a gradual dose increase. The one major drawback is that exenitide must be administered by injection. While exenatide is not approved yet for the treatment of type 2 diabetes, the studies do look promising. We expect exenitide may be available at the Westside Center through clinical trials in 2004.
	Photos By Mark Harmel ©2001/2002 USC. All Rights Reserved

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