Hitting the panic button – diabetes, Byetta, and pancreatitis

So there have been a lot of headlines lately about Byetta and pancreatitis. We think these headlines have created unnecessary alarm for patients and believe that the facts haven’t been well stated. Thirty-six patients have reported pancreatits, including six that have died. But more than one million people have been on Byetta.

Consider the context: in the population of people without diabetes, 1 in 3,000 would be expected to develop pancreatitis, compared to 3 in 3,000 for people with diabetes. So doing the math, if 1,000,000 people have taken Byetta, it would be expected that about 1,000 people would be expected to get pancreatitis. Unfortunately, it’s not that uncommon. Worse, there are lots of other drugs that can cause it, like blood pressure and epilepsy medicines.  We never ever take patient safety lightly, but it's fair to say we also care greatly about patient access to medicine. Access to Byetta might be reduced because headlines could affect how doctors evaluate risk – especially articles that provide little context. 

Some more context. Every day in the US, 4,100 people with diabetes are diagnosed, 55 people with diabetes go blind (fifty-freaking-five!), 120 people with diabetes are put on dialysis, 230 people with diabetes find out they need an amputation, and 810 people with diabetes die.  They die for many reasons, but the most tragic in our view is that they never received the right education or medicine or, for whatever reason, could not adhere to their medical program. (Some say, “Oh that patient was not compliant,” as if is their fault. We hate that word.)

We know 80% of type 2 diabetes would disappear if we could make obesity disappear. Six deaths due to any complication of diabetes over two and a half years is awful but not because it might be related to a certain drug - it's awful because this happens to people with diabetes in general and it likely could have been prevented with the right education and therapy. So for the headlines to scream about six deaths for people on Byetta – how about all the other deaths that are happening that no one is writing about? Given that, we care most about good treatments to which patients can more easily adhere.  According to many on our diaTribe advisory board, patients often stop taking drugs if they make them gain weight, if they cause hypoglycemia, etc. – these are two things that Byetta doesn’t do, and so we applaud its relatively minimal side effects. Byetta can also cause nausea, which is clearly a negative for those patients that experience this – we are happy to learn that the “next generation” Byetta has 30% less nausea associated with it.

Last, we think it’s important to look at details. For example, five of six deaths being written about had lots of confounding variables – for example, patients had gallstones, leukemia, or were severely obese,

With headlines like “Patients dying on Byetta,” it sounds like Byetta is being blamed – based on the numbers that would be expected to develop pancreatitis for those with diabetes (3 in 3,000), we think that is misleading.

If the press wants patients to hit the panic button, it should suggest doing so over the millions of patients globally who develop diabetes each year (over a million in the US alone each year), over a medical community incapable of providing adequate care (over ten million people with diabetes have an A1c over the ADA target), and a society that can’t pay for poor outcomes. That is far better than scaring patients and PCPs with useless chatter about inconclusive data and made-up epidemiology.

Comments

[Cherise Shockley]

I have been living with Diabetes for 4 years. I have read many articles and blogs about diabetes. This particular blog post you wrote struck a cord. I would really like to place your blog on my blog, if it is ok with you. I think this needs to be read by everyone. Good JOB!

Cherise Shockley