Incretin-based therapies were linked to a modest increase in biliary disease but not acute pancreatitis in adults with T2DM. The study, published in Diabetes Care, analyzed data from Medicare Fee-for-Service and two U.S. commercial claims databases spanning 2014 to 2021.

Each cohort included more than 1.2 million patients with T2DM, matched using propensity score–based fine stratification across 92 covariates. Compared with sodium–glucose cotransporter 2 inhibitors (SGLT2is), both GLP-1RAs and DPP-4is had no significant increase in acute pancreatitis risk (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.90–1.13 and HR 1.00; 95% CI 0.85–1.15, respectively). However, both drug classes were associated with a modest rise in biliary disease (GLP-1RAs HR 1.15; 95% CI 1.05–1.26; DPP-4is HR 1.22; 95% CI 1.03–1.46).

No differences were seen when comparing GLP-1RAs directly with DPP-4is for either endpoint. These results suggest that incretin-based treatments remain safe for pancreatic health while warranting mild caution regarding biliary outcomes.