One of the first points to stress in this argument is that all the diabetes drugs including Incretin based therapies have played a very important role in preventing the potentially devastating diabetes related complications.

We have all seen patients whose diabetes has resulted in loss of vision, loss of a limb or who have ended up needing dialysis or a kidney transplant. The most frequent complication of all in Type 2 diabetes is the premature loss of life from coronary heart disease.

In offering clinical advice we have to balance the known very high morbidity associated with poor diabetes control with what is in fact a very low relative risk of drug side effects. In so doing we have to take into account the seriousness of any potential side effect because this might change our overall view however small the risk.

The first clinical concern to emerge from the Incretin based drug story was a potential to induce cancer of the thyroid. Happily the data relating to laboratory rodents who were particularly prone to this problem did not translate into a higher incidence of human thyroid cancer. This did however cause concern for some time and it is still being monitored. We may now be experiencing a similar story with the pancreas and maybe we just need time to ride it out as further data is collected.

The point here is that there will always be concern for potential side effects of any drug. Counteracting these concerns is a matter for rigorous scientific research. This should be properly conducted, reported in a transparent manner and communicated in a coherent fashion.

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