A class of diabetes drug appears to double patients' risk of acute pancreatitis, according to a new study, quantifying for the first time a known risk associated with the medication.
Research appearing in JAMA Internal Medicine says the drugs – the basis of which is a compound known as glucagon-like peptide-1, or GLP-1 – are twice as likely to send users to the hospital for pancreatitis than other medications.
Pancreatitis is a sudden inflammation of the pancreas, an organ that produces enzymes and several hormones, including insulin. The enzymes normally work in the small intestine, but if they become active before leaving the pancreas, they eat away at its tissue, which damages the organ and causes abdominal pain, fever and nausea.
The drugs, sitagliptin and exenatide – which are sold under the brand names Januvia and Byetta – were found to contribute to lesions in the pancreas, which ultimately resulted in widespread inflammation of the organ.
In a statement, the study's author, Dr. Sonal Singh, said GLP-1-based drugs are "very effective" when it comes to lowering blood sugar, but noted that "important safety findings may not have been fully explored."
Dr. Farid Hassanpour, the chief medical officer at St. John's Well Child and Family Center in South L.A., said in an email that the community clinic will "likely start [assessing] pancreatic functions of those patients that are on these medications for signs of any damage and change medications as needed."
In an ideal world, medication wouldn't even enter the picture with diabetic patients. Hassanpour wrote that the treatment plan for diabetes "always starts with education, diet and exercise." Failing that, a health provider may prescribe medication. And even then, GLP-1-based drugs are only for poorly-managed, serious cases, and so aren't the first – or even second or third – resort.
Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic, also in South L.A., expanded on that, saying that "these are not first-line drugs."
"The GLP-1s are used with people [whose diabetes is] not controlled with insulin and other first-line drugs," he said, noting that a number of UMMA's patients are on Januvia or Byetta.
"If you're newly-diagnosed, or if your diabetes is mild, you're not going to get prescribed these," he said. GLP-1s, added Aguilar, are reserved for patients whom the first-line treatments fail.
"Patients on [GLP-1-based] medication have to be closely monitored for signs and symptoms of pancreatitis," he said.
The latest county data shows that nearly 12 percent of South Los Angeles residents have diabetes, down from nearly 15 percent in 2005 but up from around 11 percent in 2002. Aguilar added the federal Food and Drug Administration will monitor the situation and could take action if any further adverse developments occur.