Incretins, Diabetes, Pancreatitis and Pancreatic Cancer: What the GI specialist needs to know

Abstract

Background/purpose: There has been recent concern over the pancreatic safety of incretin-based therapies for diabetes. While drug-induced pancreatitis is a rare event, the large number of patients with diabetes make the potential impact of diabetic drugs significant. This review examines the relationship between diabetes, pancreatitis, and pancreatic cancer and the data assessing the potential impact of incretin-based therapies on these diseases.

Methods: This narrative review assesses the current data assessing the potential role of incretin-based therapies causing pancreatitis or pancreatic cancer. Accompanying articles examine the role of incretin-based therapies in managing Type 2 diabetes, and the basic science studies examining the interaction of these drugs with the pancreas.

Results: There is a strong relationship between diabetes, pancreatitis, and pancreatic cancer. Diabetes is a risk factor for acute pancreatitis, and for pancreatic cancer. Chronic pancreatitis can cause diabetes, and is a risk factor for pancreatic cancer. Finally, pancreatic cancer can cause diabetes. These complex interactions make it difficult to sort out the potential impact of incretin-based therapies in these conditions. While early anecdotal reports identified a serious safety signal in the pancreatic risk of these agents, subsequent careful studies and meta-analyses did not identify a measurable risk of pancreatitis or pancreatic cancer from these drugs. However, the risk estimates are wide and events are rare, meaning that a slight increase in risk could have been missed.

Conclusion: Diabetes, pancreatitis, and pancreatic cancer have complex relationships, with each serving as both a cause and a consequence of the others. Current analyses do not support an additional risk of pancreatitis or pancreatic cancer from the use of incretin-based therapies for diabetes.