New Injectables for Diabetes: Shots that aren’t insulin are becoming popular among diabetics

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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No, it’s not insulin. New injections for diabetes may change the way we manage adult-onset diabetes. Approval of a new once-a-week injection called Bydureon is an exciting new option for blood sugar control. This new class of injectables may be popular for several reasons, not the least of which is they also result in weight loss. Yippee!

Though it sounds straight out of outer space, these drugs are called incretin mimetics, meaning they mimic the incretin hormones that tell your body to release insulin after eating. These drugs work in very cool ways by enhancing insulin secretion, slowing stomach emptying, reducing food intake, and promoting proliferation of β-cells (cells that make insulin).

Byetta (exenatide) was the first in this class and is used to improve blood sugar control in adults with type 2 diabetes. The most interesting part is that exenatide is an amino acid isolated from the salivary gland venom of the Gila monster. There are now three choices in this class: Byetta, Victoza and the newly approved Bydureon. All three may be used with other oral diabetes medicines. All three are used to treat adult onset diabetes and all three result in weight loss, a nice bonus.

So how are Byetta, Victoza and the new Bydureon different?

Byetta (exenatide) is injected twice a day before your morning and evening meal.

Victoza (liraglutide) is given once a day instead of twice a day (like Byetta).

The just-approved Bydureon is an extended release form Byetta (exenatide). Bydureon is attractive because it is a once-weekly injection.

While all of them may cause some nausea/vomiting, this is higher with Byetta and was the most common adverse event associated with Byetta. The nausea/vomiting decreases in frequency and severity over time.

Reports of pancreatitis have dogged all of these medications and are something we need to keep a close eye on.

Bydureon once weekly may also carry the indication for monotherapy (it may be used as a first line medication for adult onset diabetes) as opposed to the other two which are added to your other oral medications for diabetes (metformin, Januvia or Actos).

Dr O.

Byetta and Victoza are both typically considered Tier 2 medications by insurance, meaning you’ll have a moderate co-pay. It is likely that Bydureon will also be considered a Tier 2 drug, but possible that as a new medication it may be Tier 3, meaning a higher co-pay, or not covered. Byetta ranges from about $150 – $300 per injection, depending on the strength, and Victoza tends to cost about $125 – $175.

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