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Am Fam Physician. 2007;75(9):1304

Author disclosure: Nothing to disclose.

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.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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