Every resource for new drug development for treatment of diabetes is focused along a single pathway.  Incretins are hormones that come from the gut and control our reaction to the foods we eat.  They are pivotal in how well our body responds to our diet and our blood glucose control.

The two main incretins in our bodies are Glucagon Like Peptide (GLP-1) and Gastric Inhibitory Peptide (GIP).  GLP-1 has a very short life in our bodies–it is broken down by the enzyme DPP-4 in a matter of 1-5 minutes.  Byetta and Victoza are two brand name drugs that mimic our own GLP-1.  Januvia was the first drug to market that stops the enzyme DPP-4; all the latest drugs all have “gliptan” in their names.

Overall, this approach is THE Holy Grail of diabetes drug development right now.  Most of the research studies focus on these pathways.

My concern over this approach is the long term effects on the pancreas.  This pathway basically lights a fire under the gluts of the beta cells of our pancreas.  These are the cells that produce insulin.  Too much stimulation is likely to burn out the pancreas.  This is my concern over long term use of this class of drugs, based on the problems with the sulfonylurea class of drugs (think glyburide, glipizide) that actually increase the risk of a Type 2 diabetic becoming insulin dependent.

However, this particular article has raised other, graver concerns.

Basically, it is already known that overstimulation of GLP-1 pathways may lead to the development of thyroid cancers in rats.  This study took this a step further and looked at whether this same potential exists in human thyroid tissue.  And, of course, it does.

The bottom line is that anytime we try to mess with human physiology using brand new compounds that the human body has never seen before, we run the risk of really, really screwing things up.  We also think we know what an enzyme or hormone does, but we truly don’t find out everything until a drug has been used in a large scale clinical trial (in other words, having the new drug released out to the unsuspecting public to be used on a massive scale).  That is when, years later, we see the bad side effects of drugs coming out (think Vioxx and heart attacks).

This of course just reinforces my belief that the ONLY answer is lifestyle changes.  Anything else is likely going to kill you before the actual disease you are trying to manage would have.  Period.