Incretin based therapy is the broad term that includes our new GLP-1 receptor agonists. It’s a mouthful, but they are the new heroes in the treatment of type II diabetes given their effectiveness and ability to help you lose weight.
GLP-1 receptor agonists are all injections which differ in how often you give them. They all may cause nausea which thankfully tends to diminish over time. They potentially carry a very small risk of pancreatitis, which is difficult to sort out because the risk of pancreatitis is higher in type II diabetics anyway. This risk is being investigated, so we’ll know more later but at this point the risk of acute pancreatitis is very small and we can’t say these medications “cause” pancreatitis.
Comparisons between liraglutide (Victoza) to twice a day exenatide (Byetta) show that Victoza lowers A1c more with the same degree of weight loss. Remember that Victoza is once a day while Byetta is twice a day. Byetta cannot be used in folks with renal (kidney) impairment while Victoza can.
Once a week exenatide (Bydureon) causes less nausea than twice daily exenatide (Byetta). Bydureon lowered Hgb A1c more than Byetta. Bydureon lowered Hgb A1c less than Victoza (less by a very small margin) but also had less nausea than Victoza. Hmmm so Bydureon may not lower sugars as well as Victoza, though it’s close, but results in less nausea.
As always, find out the individual cost of these medications for you, think of whether you prefer a daily injection or a weekly injection, and talk to your doctor about which one is a fit for you. Byetta clearly is the most cumbersome (twice a day injections), is less effective at lowering your blood sugar, and causes more nausea, so my gut is we’ll be moving away from Byetta and toward the others.
With a discount, Byetta costs more than $375 per month (1 60-dose pen), regardless of whether you use a 5 mcg or 10 mcg dose. One month of Victoza (2 pens, at a dose of 1.2 mg per day) is even more, typically $550 or higher. Bydureon, even only used once per week, is the most expensive, at $400 or more per weekly dose. If covered, all three are considered tier 2 prescriptions by many insurance plans, and tier 3 by some others, meaning a moderate to high co-pay. All three also have manufacturer coupons available that will let you save up to $100 per fill. You can find the Victoza coupon here, the Byetta coupon here and the Bydureon coupon here.
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