Amylin Pharmaceuticals, Inc., and Eli Lilly and Company have announced that Byetta (exenatide) injection has been approved for expanded combination therapy in people with type 2 diabetes who have not achieved adequate blood sugar control on a thiazolidinedione (TZD). The drug, the first in a new class called incretin mimetics, lowers both post-meal and fasting glucose levels, resulting in better long-term control as measured by HbA1c. It stimulates insulin secretion only when blood sugar is high, and restores the first-phase insulin response (an activity of pancreatic cells that is lost in patients with type 2 diabetes), among other effects. “The combination of exenatide with metformin, sulfonyl-ureas, or TZDs not only expands our options to achieve optimal glycemic control, but does so with accompanying weight loss,” said Robert Ratner, MD, vice president for scientific affairs at the MedStar Research Institute in Washington, D.C.