# Intraductal Papillary Mucinous Neoplasms and GLP-1 Receptor Agonists: Navigating Therapeutic Uncertainty in Diabetes Management

## TL;DR

This paper discusses the challenges of using GLP-1 receptor agonists for diabetes in patients with pancreatic tumors, balancing benefits and risks.

## Contribution

Proposes a risk-stratified approach for using GLP-1RAs in patients with IPMNs, integrating molecular, clinical, and practical insights.

## Key findings

- Current evidence shows limited data on GLP-1RA safety in IPMN patients.
- A risk-stratified approach is recommended to balance metabolic benefits and potential oncogenic risks.
- Shared decision-making and enhanced surveillance are emphasized for clinical management.

## Abstract

The management of type 2 diabetes in patients with intraductal papillary mucinous neoplasms (IPMNs) presents a growing clinical dilemma. As glucagon-like peptide-1 receptor agonists (GLP-1RAs) become first-line therapies for diabetes and obesity, their safety in patients with premalignant pancreatic lesions remains uncertain. This viewpoint examines current evidence through three critical lenses: molecular mechanisms linking incretin signaling to IPMN progression, clinical outcomes from large-scale pharmacovigilance studies, and practical management considerations. We propose a risk-stratified approach that balances the proven metabolic benefits of GLP-1RAs against theoretical oncogenic risks, emphasizing the need for shared decision-making and enhanced surveillance protocols.