Side by side

1. 1.Binds GLP-1 receptors on beta cells and increases insulin release only when glucose is elevated.
2. 2.Suppresses glucagon secretion.
3. 3.Slows gastric emptying, so the post-meal glucose peak is lower and later.
4. 4.Reduces appetite through hypothalamic signalling.
5. 5.A single amino-acid difference from human GLP-1 blocks DPP-4 cleavage, extending its half-life.

• Type 2 diabetes as add-on therapy (AMIGO and DURATION programmes)
• Cardiovascular safety and outcomes (EXSCEL)
• Weight change as a secondary endpoint
• Postprandial glucose control versus insulin
• Renal effects in observational cohorts

• HbA1c reductions of roughly 0.8 to 1.0 percentage points
• Weight loss of about 1.5 to 2.5 kg in trials
• Lower post-meal glucose excursions
• EXSCEL showed cardiovascular safety without a clear outcome benefit
• Antibodies to exenatide form in a proportion of patients and can blunt the response

• Nausea, vomiting and diarrhoea, common early and dose-related
• Injection-site nodules with the once-weekly microsphere form
• Hypoglycaemia when used with a sulfonylurea
• Headache and dizziness
• Pancreatitis (rare)
• Antibody formation reducing effect

Research context only - prescription medicine. The immediate-release label starts at 5 micrograms subcutaneously twice daily within 60 minutes before meals, rising to 10 micrograms twice daily; the once-weekly form is 2 mg subcutaneously. Trial durations were typically 24 to 30 weeks, with EXSCEL following participants for a median of 3.2 years.

Research context only