New Therapies Useful for Type 2 Diabetes

NEW YORK (Reuters Health) - Treatment with inhaled insulin or exenatide, an injectable drug, can improve blood sugar control in patients with type 2 diabetes who don't have a good enough response with pills, according to the findings of two studies reported in the Annals of Internal Medicine.

In one study, Dr. Julio Rosenstock, from the Dallas Diabetes and Endocrine Center in Texas, and colleagues assessed the effect of inhaled insulin on sugar control in 309 patients when substituted for or added to standard oral medications. The subjects were followed for 12 weeks.

Compared with continued oral therapy alone, a significant improvement in sugar control was achieved by substituting or adding inhaled insulin therapy, the investigators report.

Inhaled insulin therapy was more likely than oral therapy alone to produce excessively low sugar levels. Treatment was also associated with mild weight gain and mild cough.

In the second study, Dr. Robert J. Heine, from VU University Medical Center in the Netherlands, compared the sugar-lowering effects of exenatide and insulin glargine in 551 patients with type 2 diabetes who had poor sugar control with oral medications.

At 26-week follow-up, exenatide and insulin glargine were associated with similar improvements in sugar control.

Treatment with exenatide was tied to a drop in body weight of 5 lbs., while insulin glargine was linked to 4 lbs. of weight gain. Gastrointestinal side effects, such as nausea, vomiting, and diarrhea, were much more common with exenatide than with insulin glargine.

"The results of the studies in these two papers suggest a real advance in managing the later stages of diabetes: achieving glucose control without concomitant weight gain (exenatide) and a real choice for patients who dislike the prospect of injections (inhaled vs. injected insulin)," Dr. Richard J. Comi, from Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, writes in a related editorial.

SOURCE: Annals of Internal Medicine, October 18, 2005.