Can long term exenatide treatment improve beta-cell function?

This study evaluated the effect of chronic exenatide treatment on beta-cell function and insulin sensitivity in type 2 diabetes.

Management of type 2 diabetes is based on a combination of diet, exercise and oral medications focused on keeping blood sugar (glucose) levels as close to normal as possible. However, as diabetes progresses, the pancreatic cells responsible for producing and secreting insulin, known as pancreatic beta-cells, degenerate and lose function over time. Therefore, the preservation of pancreatic beta-cell function has recently received a major role in the management of recently diagnosed diabetes.

Glucagon-like peptide-1 (GLP-1) is a hormone that causes an increase in the amount of insulin secreted from the beta-cells in the pancreas after eating. Glucagon-like peptide-1 agonists, such as exenatide (Byetta), are a class of drugs that mimic the effects of GLP-1, enhancing glucose-dependent insulin secretion. While previous studies have demonstrated the effectivity of exenatide in reducing blood glucose levels and lowering HbA1c levels (an indicator of average blood glucose levels of the previous 3 months), the effects of chronic exenatide use on pancreatic function has not yet been thoroughly investigated. 

79 patients recently diagnosed with type 2 diabetes and not previously treated with any medication were randomized to receive either exenatide or a placebo for a total of 24 weeks. 24 patients were randomized to receive a placebo, 26 patients received 5 μg of exenatide twice daily and 29 patients received 10 μg of exenatide twice daily.

After 24 weeks of treatment, patients receiving any dose of exenatide achieved more significant decreases in HbA1c levels compared to patients receiving a placebo. An average decrease of 0.77% was noted among patients receiving 5 μg exenatide and of 0.86% among those receiving 10 μg exenatide.

Treatment with10 μg exenatide was associated with significantly increased beta-cell function (as evaluated by pancreatic response to glucose and insulin secretion rates). Chronic treatment with 10 μg exenatide was also noted to reduce removal of insulin by the liver and significantly increase insulin sensitivity.

This study concluded that exenatide treatment increases pancreatic beta-cell function and may significantly delay the progression of recently diagnosed diabetes.

Consult with your physician regarding the risks and benefits of GLP-1 agonists in the preservation of pancreatic function and the management of type 2 diabetes.