Intended for healthcare professionals


Incretins and cancer of the bile duct in type 2 diabetes

BMJ 2018; 363 doi: (Published 06 December 2018) Cite this as: BMJ 2018;363:k5155

Linked research

Incretin based drugs and risk of cholangiocarcinoma among patients with type 2 diabetes

  1. Amanda I Adler, consultant physician
  1. Addenbrooke’s Hospital, Cambridge, UK
  1. amanda.adler{at}

Existing trial data could help characterise this new association

Is this issue of The BMJ, Abrahami and colleagues (doi:10.1136/bmj.k4880) report that use of dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists (collectively called incretins) “might be associated with an increased risk of cholangiocarcinoma in adults with type 2 diabetes.”1 If incretins are associated only indirectly with cholangiocarcinoma, people with diabetes would not have a problem. The issue for patients, doctors, and regulators is establishing for certain whether these drugs cause cholangiocarcinoma, a conclusion that this single observational study cannot support.

Abrahami and colleagues’ well executed pharmacoepidemiological study shows that people who take incretins have higher rates of cholangiocarcinoma than people who do not take incretins. One possibility is that non-incretin treatments prevent cholangiocarcinoma—an interpretation the authors discount. Another possibility is that incretins cause cholangiocarcinoma. Concluding this from an observational study (even a good one) might be like concluding that hospitals cause people to die—while knowing …

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