One area of concern with this class,as well as the other incretin-based category, the glucagon-like peptide 1 (GLP-1) receptor agonists, has been pancreatic safety--both regarding possible pancreatitis and pancreatic neoplasia. The prescribing guidelines for these drugs include cautions about using them in individuals with a prior history of pancreatitis. While this is reasonable, emerging data from large
observational data sets, as well as from two large cardiovascular trials with DPP-4 inhibitors, have found no statistically increased rates of pancreatic disease. Generally speaking, the use of any drug in patients with type 2 diabetes
must balance the glucose-lowering efficacy,side-effect profiles, anticipation of additional benefits, cost, and other
practical aspects of care, such as dosing schedule and requirements for glucose monitoring. The patient--who is obviously the individual most affected bydrug choice--should participate in a shared decision-making process regarding
both the intensiveness of blood glucose control and which medications are to be selected.