Back when I was younger, whenever I heard the words “diabetes” and “treatment” in the same sentence, my brain would only conjure up insulin shots. I do not have diabetes, yet a few of my close ones do. Because of that, as I grew up, I learned that an insulin shot is not the ultimate and sole treatment for all diabetics.
To clarify, if the pancreas is still able to secrete insulin hormone in type 2 diabetes — less than of an average person’s — certain pills can be used in order to increase the little amount of insulin that these people’s pancreases produce. Again, this is only possible for type 2 diabetics (unless their pancreas has stopped producing insulin as a whole) since compared to type 1 diabetics, whose pancreas' cannot secrete insulin at all, type 2 diabetics are mostly able to do so. Besides secreting less than ideal amounts of insulin, in type 2 diabetes, one of the leading causes of the disease may be the erroneous working way of insulin as well. Medications that are used to treat type 2 diabetes differ a lot depending on their specific purpose inside the body and in which part of the process or location.
One of the medications that are used in order to treat diabetes is Sitagliptin. This medication takes an indirect approach. What it does is it increases incretin levels. Incretin is a hormone secreted moments after eating, and starts circulating in the blood. It affects the amount of insulin hormone produced after consumption (Kim, Wook). Therefore, an increase in incretins eventually causes an increase in insulin hormones; this consequently lowers the blood glucose level (which is the glucose that circulates inside the blood to be sent to cells by using insulin hormone to help them enter, just like a key to a house)(WebMD).
While the generic name of this medicine is Stagliptin, one of its brand names is Januvia in the U.S. (“Sitagliptin Uses, Side Effects & Warnings.”) This drug is taken orally and can be used in the treatment of type 2 diabetes. By controlling the insulin level in the bloodstream, the medicine controls the blood glucose levels (“Januvia: Uses, Dosage, Side Effects.”)
If you are diabetic, or have a close one who is, or just like to follow the news, you are likely to remember the name of this medicine. Because recently, the FDA (Food and Drug Administration) announced that the samples of Januvia and Janumet (a drug containing Stagliptin and Metformin combined) used in type 2 diabetes treatment, “were contaminated with a possible carcinogen”(Reuters) and contained traces of it. The impurity found in the drugs is called NTTP, belonging to the nitrosamine class of compounds, in which some of them are classified as possible carcinogens (U.S. Food and Drug Administration, FDA). Yet, it is not certain that NTTP is actually carcinogenic because there is a lack of data to directly reach that conclusion. Instead, what the FDA does is compare other nitrosamine compounds with NTTP in order to determine the boundary for exposure to NTTP (U.S. Food and Drug Administration, FDA).
The company, Merck, after finding traces of NTTP, reached regulators and authorities in order to address the situation (Reuters)(The New York Times). Besides everything, FDA allowed the drug’s temporary use even though it surpasses the intake limit, to avoid shortages of the medicine and to allow access to the patients who require it.
I believe that letting people take a medicine even though it contains a possible carcinogen demonstrates the dire need for diabetes treatment and medication in the U.S. Yet, it also portrays how carcinogens we consume have become a normalcy and even have an intake limit. Regardless, this news helps us wonder: Do we truly know what we are putting into our bodies?
Kim, Wook, and Josephine M Egan. “The Role of Incretins in Glucose Homeostasis and Diabetes Treatment.” Pharmacological Reviews, U.S. National Library of Medicine, Dec. 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696340/.
“Sitagliptin Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing.” WebMD, WebMD, https://www.webmd.com/drugs/2/drug-145697/sitagliptin-oral/details#:~:text=Sitagliptin is a diabetes drug,of sugar your liver makes.
“Januvia: Uses, Dosage, Side Effects.” Drugs.com, https://www.drugs.com/januvia.html#:~:text=Januvia is an oral diabetes,with type 2 diabetes mellitus.
“U.S. FDA Says Possible Carcinogen Found in Some Merck Diabetes Drugs.” Reuters, 9 Aug. 2022, https://www.reuters.com/business/healthcare-pharmaceuticals/fda-says-found-possible-carcinogen-certain-samples-mercks-januvia-2022-08-09/.
Center for Drug Evaluation and Research. “FDA Works to Avoid Shortage of Sitagliptin.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/drugs/drug-safety-and-availability/fda-works-avoid-shortage-sitagliptin-following-detection-nitrosamine-impurity.
Jacobs, Andrew. “Samples of Popular Diabetes Drug Contain Potential Carcinogen, F.D.A. Says.” The New York Times, The New York Times, 11 Aug. 2022, https://www.nytimes.com/2022/08/11/health/diabetes-januvia-cancer.html.
Image Source: Wikimedia Commons. https://commons.wikimedia.org/wiki/File:People%27s_health_and_wellness_with_drugs%28medicine%29.jpg