Intended for healthcare professionals

Feature Diabetes Drugs

Has pancreatic damage from glucagon suppressing diabetes drugs been underplayed?

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3680 (Published 09 June 2013) Cite this as: BMJ 2013;346:f3680

Re: Has pancreatic damage from glucagon suppressing diabetes drugs been underplayed?

In light of the concerns and controversy over GLP-1 drugs raised by Deborah Cohen’s illuminating article. (1) I would like to reiterate my concerns raised in two rapid responses published in March 2013 by the BMJ. (2) http://www.bmj.com/content/346/bmj.f1304?tab=responses Jane E Collis.

Type 2 diabetes (T2DM) is a worldwide epidemic involving countries living in extreme poverty, can we really imagine that expensive treatments such as GLP – 1 drugs will be at the forefront of T2DM management?

As the UK National Institute of Clinical Excellence (NICE) suggests ‘The necessary lifestyle changes, the complexities of management and the side effects of therapy make self-monitoring and education for people with diabetes central parts of management.’ (3) Yet how many people actually receive adequate education on how to live a ‘normal’ life with type 2 diabetes?

The sheer scale of the diabetes (T2DM) epidemic means that resources can be severely limited. Problems which were highlighted by diabetes consultants Kilvert and Rayman who describe the crisis in diabetes care in England alone as being catastrophic. (4) This sorry state of affairs also reflects the poor management of this crisis from a global perspective.

The scale and lack of understanding of the complexities of this disorder has left the door wide open for drug companies to tout their ‘wonder cures’ for T2DM. It is of course obvious that the real target market is obesity management; a quick fix without any need for any changes in eating habits or lifestyle management.

New advances in drug therapies are futile if the very basic education of how to live and stay healthy with diabetes is inadequate – sometimes abysmal.

I note that the GLP-1 drug Liraglutide (Victoza) was tested against Rosiglitazone (Avandia) in the Novo Nordisk LEAD drug trials and found to produce greater improvement in glycaemic and weight control. (5) (6) Hardly a glowing recommendation for a drug safety and efficacy profile! Patient safety and consideration should be the highest priority. I fervently hope the growing concerns over GLP-1 drugs are not ignored.

(1) Has pancreatic damage from glucagon suppressing diabetes drugs been underplayed? Deborah Cohen. BMJ 2013;346:f3680.

(2) http://www.bmj.com/content/346/bmj.f1304?tab=responses Two rapid responses 4th March 2013 Jane E Collis to: Two drugs for type 2 diabetes seem to raise risk of acute pancreatitis, study shows. BMJ 2013;346:f1304

(3) http://publications.nice.org.uk/type-2-diabetes-cg87 (Accessed 16th June 2013)

(4) Kilvert A Rayman D The crisis in diabetes care in England BMJ 2012;345:e5446

(5)Marre M, Shaw J, Brändle M, et al; LEAD-1 SU Study Group. Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with type 2 diabetes (LEAD-1 SU).Diabet Med. 2009;26(3):268-278.

(6)http://www.novonordisk.com.au/media/PIs/Victoza_pi4a.pdf (Accessed 16th June 2013)

Competing interests: No competing interests

17 June 2013
Jane E Collis
Independent Researcher
No affiliation
Kenilworth Warks UK