A good going controversy. Just what we needed to brighten up the diabetes scene. It was getting a bit dull these days with Rosiglitazone being out of the picture. Thank god for a new candidate to fret and fume on.
So are endocrinologists holding their breath country wide in anticipation of the hammer rapping andthe jury shaking their heads while the accused GLP-1 mimetics are led off the stand to their eternal resting place beyond the yonder? I suspect not. Not because they can't be bothered, but because they are too busy dishing out the mimetics, trying to meet the demanding clamour of the obese patients knocking on endocrine doors for a weapon to ward off their perennial enemy, the fat.
I wonder whether there might be another reason why endocrinologists are not too worried about the concerns that have been raised about the GLP-1 mimetics. They have seen this all before. Sibutramine, Rimonabant, Troglitazone, Rosgilitazone to mention a few. Been there, dished that. Stopped that. Next please.
And ofcourse, endocrinologists prescribe testosterone replacement. Fears of prostate cancer havent stopped anyone. But the similarities with GLP-1 treatment are interesting.
GLP-1 is a hormone replacement, supplementing a hormone that has become low in the body. So is testosterone replacement. Tick
Replacement is to help with lifestyle. Lose weight with one, have sex with the other. Tick
Lack of replacement facilitates weight gain. Treatment helps reduce fat gain. Check.
Replacement improves energy levels and well being. Check
Over replacement is possible and can stimulate neoplasia development. Pancreas vs Prostate. Tick
Long term monitoring required to detect side effects including cancer. Tick.
I am not sure what the fuss is about. Maybe just because it is still early days. Maybe there are differences?
Maybe because we are not replacing the actual hormone GLP-1 but an analog (although the blame is not on the molecule but on its post receptor action?)
Maybe because we don't measure serum exenatide levels to see therapeutic levels and avoid over-replacement?
Maybe because we don't know whether it produces cancer or merely stimulates growth of cancer already present?
Maybe because we don't know about a marker better than CA19-9 that could work like PSA in early detection?
Or, Maybe, Just maybe, because we can trust no one anymore. The financial implications for companies and the NHS coupled with the vested interests of drug companies and frustrated doctors to keep the diabetic therapeutic armamentarium alive have eroded the trust and increased scepticism for all data that is grey. We need to be seen as treating with something. We need something to dish out for sure. We need something robust. We need it to be totally safe. We need to know for sure. We cannot live with uncertainty anymore. Eating less and exercise are just not enough. We need to dish out something to reduce cardiovascular risk, 10 years down the line, 100 years ideally.
Anyway, I am more interested in waiting for the bad news on Dapagliflozin. Personally, i think that is worse!
But that is another blog all together. See you there.