The Debate Continues

The Debate Continues

“The available evidence suggests that the incidence of pancreatitis among patients using incretins is low and that the drugs do not increase the risk of pancreatitis. Current evidence, however, is not definitive, and more carefully designed and conducted observational studies are warranted to definitively establish the extent, if any, of increased risk.”  This is the conclusion of a study that was published in the British Medical Journal (BMJ) back on April 15th. This meta-analysis looked 55 randomized controlled trials and five observational studies.

This most recent meta-analysis is just the latest in a series of studies looking into whether there is a causal effect between GLP-1 usage and pancreatic issues.  Like the studies that have come before it, this one cannot say conclusively that GLP-1 usage increases the risk of pancreatic issues.  The simple fact is the diabetes research community just cannot get away from this issue and seems intent on conducting even more studies that in all likelihood will conclude the exact same thing, based on all available evidence there does not appear to be a causal relationship between GLP-1 usage and pancreatic issues.

Perhaps it’s time someone asks why researchers are so obsessed with this issue.  This fascination on GLP-1 usage and pancreatic issues is reaching the point of being counterproductive.  It’s about time everyone accept certain facts. First and most importantly we’ll never have a clear and definitive study that states with 100% certainty that GLP-1 usage does or does not increase the risk of pancreatic issues. Fact number two, every drug and we mean every drug used to treat diabetes comes with risks, some known others yet to be discovered. Fact three, as much as we hate to say this but it may be years before the full impact of GLP-1 usage is known. The same by the way can be said for DPP4’s.

Based on sales data, which thankfully is much clearer than study data, this debate hasn’t adversely impacted GLP-1 usage. GLP-1 usage continues to increase as physicians who are aware of the risks continue to see GLP-1’s as an effective tool.  They understand that unlike insulin GLP-1’s come with virtually no patient training, that there is little risk of hypoglycemia, that at worst patients won’t experience weight gain and more often than not experience weight loss. They understand that unlike insulin patients don’t need to measure their glucose levels or count carbs before dosing. Looked at realistically GLP-1 therapy is perhaps the most patient friendly therapy option available. About the only negative is that like insulin the patient must inject themselves. Yet even with this perceived negative GLP-1 usage continues to increase.

So again we ask why this obsession? Is it because GLP-1 usage is increasing and these researchers see it as their civic duty to come up with a clear and unquestionable conclusion? Have they not learned through their years of doing such research that sometimes there just isn’t a clear and unquestionable conclusion? Do they not realize that their continued obsession with this issue could actually adversely impact future diabetes drugs? Anyone who doesn’t believe this we point to how the Avandia controversy forever changed the way the FDA reviews new diabetes drugs.

Diabetic Investor does not question the need for some of these studies. What we question is the continued pursuit of even more studies on the subject. To Diabetic Investor this debate is much like two people looking at an abstract painting where one person sees a masterpiece worth millions and the other sees a piece of junk worth nothing. The fact is both people see the same painting just with a different perspective and neither is wrong in their beliefs.  It’s time that the diabetes research community realizes that as much as they don’t like it there just isn’t a clear and unquestionable answer to the question. Folks it’s time stop looking for an answer and move on.