There is no question that
incretin-based
glucose-lowering medications have proven to be effective
glucose-lowering agents.
Glucagon-like peptide 1 (GLP-1) receptor agonists demonstrate an efficacy comparable to
insulin treatment and appear to do so with significant effects to promote
weight loss with minimal
hypoglycemia. In addition, there are significant data with
dipeptidyl peptidase 4 (DPP-4) inhibitors showing efficacy comparable to sulfonylureas but with weight neutral effects and reduced risk for
hypoglycemia. However, over the recent past there have been concerns reported regarding the long-term consequences of using such
therapies, and the issues raised are in regard to the potential of both classes to promote
acute pancreatitis, to initiate histological changes suggesting
chronic pancreatitis including associated preneoplastic lesions, and potentially, in the long run,
pancreatic cancer. Other issues relate to a potential risk for the increase in
thyroid cancer. There are clearly conflicting data that have been presented in preclinical studies and in epidemiologic studies. To provide an understanding of both sides of the argument, we provide a discussion of this topic as part of this two-part point-counterpoint narrative. In the point narrative below, Dr. Butler and colleagues provide their opinion and review of the data to date and that we need to reconsider the use of
incretin-based
therapies because of the growing concern of potential risk and based on a clearer understanding of the mechanism of action. In the counterpoint narrative following the contribution by Dr. Butler and colleagues, Dr. Nauck provides a defense of
incretin-based
therapies and that the benefits clearly outweigh any concern of risk.