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Has pancreatic damage from glucagon suppressing diabetes drugs been underplayed?

BMJ 2013; 346 doi: (Published 09 June 2013) Cite this as: BMJ 2013;346:f3680

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

Dear Ms. Deborah Cohen:

Firstly, please accept my compliments about your very clever work in this research paper that brings to the the center stage many unresolved and important issues inside the type 2 diabetes world.

About two years ago I was invited to start Blogging about Diabetes to the BMJ community forum known as Doc2Doc. Here is my very first Blog, highly criticizing the large scale advertisements and acceptance by almost all stakeholders involved in type 2 diabetes care, of the so-called Incretin-Based therapies, even with already human and experimental signs of serious adverse-effects.

My question for you is: What are your clues about ALL these inertia, at least until now, with this weak and expensive class of drugs?

Here is the Blog (October 24th, 2011)

Hello Fellows:

The global pandemics of type 2 diabetes has now reached the huge number of about 350 millions of people with this disease around the globe.

Although the rigid treatment of hyperglycaemia continues to be the center stage of diabetes drug-treatment for many scientific societies, like the American Diabetes Association, the evidence for that remains poorly indicative that this is the right clinical approach.

The major goals of treatment for type 2 diabetes should be the prevention and treatment of macrovascular and microvascular complications, and a succession of major studies of intensive blood glucose lowering involving about 27000 patients with established type 2 diabetes demonstrated neutral or deleterious effects on cardiovascular mortality and no clear beneficial effects on the risks of blindness or renal failure. Why this is happening in the diabetes world?

In my opinion, this happens because, among other reasons, we, physicians, became easily happy and comfortable with surrogate markers of diseases, and doing so, accepted with no criticism the dictatorship of these surrogates for diabetes complications, like blood glucose or HBA1C levels, instead of the genuine real world cardiovascular and microvascular outcomes for diabetic complications such as coronary artery disease, myocardial infarction, stroke, heart failure, renal failure, and clinical retinopathy. The key issue here is that glycaemic levels and HBA1C are just numbers that are favoring the quite profitable (namely for the pharmaceutical companies) release into the market of expensive, and weak anti-hyperglycaemic drugs, with no proven clinically meaningful benefits, beyond a certain (albeit weak) blood glucose lowering effect.

There is no such thing as a completely safe drug, every single drug do have adverse effects, unless we are talking here about homeopathy, which is not the case. And we only realize the full drug adverse effects profile after it has been taken by millions of people for a number of years, and that is the main goal of pharmacoepidemiology studies.

Now it comes up, with no surprises, a study published in “Gastroenterology” and based on adverse events reports showing a big red flag for a new, expensive, and weak anti-hyperglycaemic class of drugs collectively known as Incretin-Based Therapies: This study found significantly increased reports for acute pancreatitis, pancreatic cancers, and thyroid cancers with this new classes of anti-hyperglycaemic drugs.

“Pancreatitis, Pancreatic, and Thyroid Cancer With Glucagon-Like Peptide-1–Based Therapies”

Of course, these kind of studies will not appear easily on our e-mail boxes. Conversely, short-term clinical studies and even meta-analysis based on surrogate markers of disease come in tons to my mail-box.

They make-me remember what Dr. William Osler said many years ago: “Never be the first, or the last, to use a new drug”.

Competing interests: No competing interests

20 June 2013
Jose Mario Franco de Oliveira
Associate Professor of Medicine
Universidade Federal Fluminense
Rua Senador Vergueiro # 2 apt. 202