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...it is predicted that by 2025, approximately 380 million adults worldwide will have diabetes (type 1 or 2). (3) This represents an ever-increasing burden upon national health care systems and on society. Therapeutic interventions that target defects in the underlying causes of diabetes are likely to improve the associated morbidity and mortality, thus help reduce the burden upon health care systems at the least. This is a report from a roundtable meeting of a select Faculty of Primary Care Diabetes Society committee members at which the initiation of exenatide (Byetta[R], Lilly) in the primary-care setting was discussed in relation to existing trial data and personal experiences of the drug's use. The Faculty's main aims were to evaluate who their 'exenatide patient' is, how and when should exenatide be initiated, what patient and healthcare professional education is necessary and what follow up is required.

The Faculty comprised (alphabetically):

* Roger Gadsby (GP, Nuneaton)

* Martin Hadley-Brown (GP, Thetford; Chair of the PCDS; and Chair of this meeting)

* Gwen Hall (DSN in Primary Care, Haslemere; and Vice-Chair of the PCDS)

* Professor Kamlesh Khunti (GP, Leicester)

* Brian Karet (GPSI in Diabetes, Bradford)

* David Millar-Jones (GPSI in Diabetes, Pontypool).

In 1967 Perley and Kipnis demonstrated that orally administered glucose has a higher effect on insulin secretion than an equivalent of intravenously administered glucose. (4) The difference between the two responses was termed the 'incretin effect' by Nauck et al in 1986 and the hormones stimulating insulin secretion the 'incretins'. (5)

The two main incretin hormones are GLP-1 and GIP (glucagon-like peptide 1 and glucose-dependent insulinotropic peptide, respectively; GIP is also known as gastric inhibitory peptide). GLP-1 is made and secreted by the L cells of the ileum and colon, it acts upon the pancreatic alpha- and beta-cells, the gastrointestinal tract, the central nervous system, the lungs and the heart. (6) GIP is synthesised and secreted by the K cells of the jejunum and duodenum and it acts primarily on pancreatic beta-cells and adipocytes. (6)

Glucoregulatory roles of GLP-1

GLP-1 is secreted within minutes of food intake. Its glucoregulatory functions include the following. (6)

* It enhances glucose-dependent insulin secretion from pancreatic beta-cells.

* It slows gastric emptying.

* It promotes satiety, thus reducing appetite....

NOTE: All illustrations and photos have been removed from this article.



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