Dr. Holst’s English wasn’t easy for me to understand from my vantage point near the back of the hall. But I was able to follow along with his PowerPoint slides.
Dr. Ratner was the big and pleasant surprise, and he made several points well worth repeating here. Unlike the two other professors, he seems to have hands-on experience in prescribing Byetta to patients.
In a question passed up to Dr. Drucker as the moderator, someone asked what Dr. Drucker says is the most common question he gets asked at presentations like these, “What diet should I be on when I use a GLP-1?”
“A low-calorie diet,” responded Dr. Ratner when Dr. Drucker passed on the question to him. “And when you feel full, stop eating.”
Dr. Ratner appropriately related this question to nausea, which almost half of the people in Byetta’s clinical trials seemed to have experienced. “But sometimes what gets coded as nausea is satiety,” he pointed out. “When you get full and don’t stop eating, you get nausea.” The problem is that so many people with type 2 diabetes have a hard time figuring out what the feeling of fullness is.
Nausea also related to gastroparesis, which is delayed stomach emptying. Dr. Ratner says that it comes in two distinct types. For some it is so serious it is an end-stage disease, but for most, who have what he calls “functional gastroparesis,” when they get their glucose levels down, the gastroparesis goes away.
Some statistics show that a quarter of people with diabetes have gastroparesis, as I wrote here earlier. But Dr. Holst noted that it’s not something that he has seen at all in his country.
Dr. Ratner thinks that GLP-1 mimetics, like Byetta and the forthcoming liraglutide, are not appropriate for these groups of people with type 2 diabetes:
- For those who don’t care about losing weight. They should stay on an oral diabetes medication, he says.
- If they are truly needle-phobic. But this is rare, he says. “I have seen only one in my life.”
- If they physically can’t handle the pen and needle.
- And if they have severe gastric problems.
But for the rest of us, Dr. Ratner concluded by saying that GLP-1 mimetics are “the perfect agents for weight loss.” Doctors should be prescribing them earlier in the course of their treating type 2 diabetes.
I would have wanted to use Byetta much earlier in the course of my diabetes. But when I got my diagnosis in 1994, the only medication available was insulin and the sulfonylureas. Byetta only became available two years ago, and I can truly say that it changed my life.
