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Diabet Med. 2019 Apr;36(4):491-498. doi: 10.1111/dme.13835. Epub 2018 Oct 25.

Treatment with incretins does not increase the risk of pancreatic diseases compared to older anti-hyperglycaemic drugs, when added to metformin: real world evidence in people with Type 2 diabetes.

Author information

1
Statistics Unit, QIMR Berghofer Medical Research Institute.
2
School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.
3
Division of Endocrinology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
4
Cardiology Department, Royal Brisbane and Women's Hospital and University of Queensland School of Medicine, Brisbane.
5
Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.

Abstract

AIMS:

In people with metformin-treated diabetes, to evaluate the risk of acute pancreatitis, pancreatic cancer and other diseases of the pancreas post second-line anti-hyperglycaemic agent initiation.

METHODS:

People with Type 2 diabetes diagnosed after 2004 who received metformin plus a dipeptidyl peptidase-4 inhibitor (DPP-4i, n = 50 095), glucagon-like peptide-1 receptor agonist (GLP-1RA, n = 12 654), sulfonylurea (n = 110 747), thiazolidinedione (n = 17 597) or insulin (n = 34 805) for at least 3 months were identified in the US Centricity Electronic Medical Records. Time to developing acute pancreatitis, other diseases of the pancreas and pancreatic cancer was estimated, balancing and adjusting anti-hyperglycaemic drug groups for appropriate confounders.

RESULTS:

In the DPP-4i group, the adjusted mean time to acute pancreatitis was 2.63 [95% confidence intervals (CI) 2.38, 2.88] years; time to pancreatic cancer was 2.70 (2.19, 3.21) years; and time to other diseases of the pancreas was 2.73 (2.33, 3.12) years. Compared with DPP-4i, the insulin group developed acute pancreatitis 0.48 years (P < 0.01) earlier and the GLP-1RA group developed pancreatic cancer 3 years later (P < 0.01). However, with the constraint of no event within 6 months of insulin initiation, the risk of acute pancreatitis in the insulin group was insignificant. No other significant differences were observed between groups.

CONCLUSIONS:

No significant differences in the risk of developing pancreatic diseases in those treated with various anti-hyperglycaemic drug classes were found.

PMID:
30306620
DOI:
10.1111/dme.13835

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