Practical use of exenatide and pramlintide for the treatment of type 2 diabetes

Type 2 diabetes is a progressive disease that affects more than 20.8 million Americans. Traditional antihyperglyce-mic therapy can cause weight gain and hypoglycemia in this population. Research shows that type 2 diabetic patients have low levels of glucagon-like peptide-1 and amylin. This discovery led to the creation of 2 newer agents, exenatide and pramlintide. Exenatide, a glucagon-like peptide-1 agonist, stimulates insulin secre-tion, suppresses glucagon secretion, and slows gastric motility. Transient nausea is the most common side effect, which can be minimized with slow titration. Weight loss associated with exenatide is between 0.9 and 2.8 kg. Hypoglycemia occurs more frequently when exe-natide is used with a sulfonylurea. There are some case reports of pancreatitis in patients taking exenatide. Pram-lintide, a synthetic form of amylin, inhibits the postmeal rise in glucagon, slows gastric emptying, and promotes satiety. Common side effects of pramlintide include tran-sient nausea, headache, and modest weight loss (1.6 kg). Exenatide and pramlintide are contraindicated in patients with gastroparesis. The success of therapy with both agents is enhanced with slow titration tominimize nausea and patient counseling. Exenatide and pramlintide offer improved postprandial control with the potential for weight loss in patients with type 2 diabetes