Editorials

The safety of incretin based drugs

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2779 (Published 24 April 2014) Cite this as: BMJ 2014;348:g2779
  1. Victor M Montori, professor of medicine
  1. 1Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA
  1. Correspondence to: Montori.victor{at}mayo.edu

Latest data on pancreatitis look reassuring, but informed patients will have the final word

Important concerns have been raised about the impact of incretin based drugs on the risk of acute pancreatitis in patients with type 2 diabetes. Two linked papers by Li and colleagues (doi:10.1136/bmj.g2366) and Faillie and colleagues (doi:10.1136/bmj.g2780) could help us decide whether patients and clinicians should consider these concerns when choosing an antihyperglycemic drug.1 2

Like all other antihyperglycemic drugs, incretin based drugs—glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors or gliptins—despite their elegant mechanism, have no special ability to reduce the risk of complications of diabetes. Patients might prefer to use these drugs though as they have almost no risk of hypoglycemia, are weight neutral (gliptins) or lead to weight loss (GLP-1 agonists), and have convenient oral (gliptins) or injectable (GLP-1 agonists) dosing. Because of these favorable features, experts recommend them as second line drugs after metformin to help patients achieve glycemic control.3 Some patients might also need to consider cost, which is about 70 times higher than metformin or sulfonylureas in the United States. Should the possibility of acute pancreatitis with these drugs also affect their decision making? …

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