to the editor: The STEPS article on exenatide injection (Byetta) concluded that it is an inconvenient drug with no proven benefits over other drugs for the management of diabetes.¹ However, the authors did not discuss the weight loss benefit of exenatide in patients with diabetes who are obese.

In a clinical trial of patients with diabetes who were receiving metformin (Glucophage), the addition of exenatide was associated with progressive weight loss in obese and nonobese patients in a dose-dependent manner compared with placebo.² When used appropriately as add-on therapy, exenatide has an advantage over sulfonylureas and insulin because it does not increase the risk of hypoglycemia.

As medical director of a bariatric practice, I have seen greater weight loss in obese patients with type 2 diabetes who were receiving exenatide compared with those taking sulfonylureas, thiazolidinediones, or insulin. I also would argue that exenatide is easier to use than insulin because of its prefilled pen design and simple dosing schedule. Medications like exenatide, which may have a positive impact on the “diabesity” epidemic, warrant additional consideration.

editor's note: This letter was sent to the authors of the STEPS article, who declined to reply.