Incretin therapy has helped so many patients with diabetes achieve good control that I had to cringe when I read about the findings of a recent research study. Years ago, I remember hearing of some links between pancreatitis and incretin therapies. But now, there may be a link to pancreatic neuroendocrine tumors.
A new study from UCLA and the University of Florida that was published online in the journal Diabetes on March 22, 2013. A link has been found between patients using incretin therapy and abnormal pancreatic growth, which could be linked to pancreatic cancer. This was the first study to show an effect on the human pancreas.
The researchers looked at 20 deceased organ donors with type 2 diabetes and found that there was a 40 percent increase in pancreas size in those who were on incretin therapy. Eight of the 20 had been treated for at least a year with incretin therapy. Of the eight treated, seven were on sitagliptin and one on exenatide. They also evaluated 14 pancreases from a control group of people similar in age but without diabetes. Enrique Rivero wrote in the UCLA Newsroom news release, “Incretin-treated individuals showed an increase in pancreas dysplasia, an abnormal form of cell proliferation that is a risk factor for pancreatic cancer, as well as an expansion of alpha cells, endocrine cells that make the hormone glucagon.”
Since incretin therapies suppress the release of glucagon by alpha cells, it has been shown to induce a proliferation of pancreatic alpha cells, which can then lead to pancreatic neuroendocrine tumors. “Three of the eight incretin-treated individuals had microadenomas and one has a neuroendocrine tumor composed of alpha cells,” stated Rivero.
The researchers concluded more studies need to be done on human pancreases and we need to evaluate potentially more screening for neuroendocrine tumors and MRI imaging of the pancreas for patients on incretin therapy. We need to remember encourage our patients to discuss with their doctors the risks and benefits of all diabetes therapies.