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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?

To be fair to this class of drugs, not only the effects on the pancreas of incretin based therapies are underplayed. The side effects of all type 2 diabetes drugs are underplayed, especially lowering of blood sugar, their main therapeutic indication.
Iatrogenic hypoglycemia should not be taken lightly, whether mild or severe. We do know that hypoglycemia is associated with mortality among critically ill in-patients(1). However we have no evidence for the long term safety of having one or repeated episodes of hypoglycemia, mild or severe in diabetics. It is very likely that there is under reporting of hypoglycemia by patients on these drugs. We also know from patients' accounts of the unpleasantness of this side effect.
With a still uncertain benefit on macrovascular disease and very small potential effect on surrogate microvascular outcomes that are expected only after prolonged treatment(2), I hope that reports like BMJ's and Cohen's and similar articles will spur a fresh unbiased, unconflicted and truly evidence based thorough re-evaluation of our knowledge-base in type 2 diabetes.

references:
(1)http://www.nejm.org/doi/full/10.1056/NEJMoa0810625
(2)http://www.ncbi.nlm.nih.gov/m/pubmed/9742976/

Competing interests: No competing interests

07 July 2013
Homer U. Co
General Internist
Philippine General Hospital
Taft avenue, Manila Philippines