The development of Byetta (synthetic exendin-4; exenatide) as a treatment of diabetes arose from two, parallel lines of investigation. The development of the ‘incretin concept’ which hypothesised that hormones from the gut contributed to the insulin secretion in response to meals, led to the identification of glucagon-like peptide 1 (GLP-1) as an important ‘incretin’ hormone. GLP-1 not only increases insulin secretion but increases β-cell proliferation and survival, suppresses glucagon secretion, delays gastric emptying and suppresses appetite, all of these actions contributing to a potential anti-diabetic effect. However, GLP-1 has a very short half due to its rapid breakdown by dipeptidyl peptidase IV and ectopeptidases. A systematic investigation of the composition and activity of venom from the Gila monster, Heloderma suspectum, led to the isolation of a 39-amino acid peptide, designated exendin-4, showing 53% structural homology with GLP-1(7-36). Exendin-4 mimicked GLP-1 through stimulating the GLP-1 receptor. The much greater stability of exendin-4 led to its experimental and clinical evaluation as an anti-diabetic agent and its introduction to the market in 2005.