To the Editor We would like to highlight important methodological limitations to the case-control study by Singh et al,1 in which the authors investigated whether an association might exist between acute pancreatitis and use of glucagon-like peptide 1 (GLP-1)–based therapies in patients with type 2 diabetes mellitus using an insurance claims database.
The use of claims databases to create control populations and adjust for confounders is limited by the absence of data on relevant baseline characteristics. In Singh et al,1 the control population was developed using demographic and diabetes-related factors but not factors associated with risk of developing pancreatitis. Prevalence rates of risk factors for pancreatitis such as obesity, hypertriglyceridemia, and alcohol use are typically underestimated in claims databases, such that residual confounding likely persists despite attempts to adjust for these factors. Pancreatitis diagnoses were not confirmed through medical chart review but were based on an algorithm with positive predictive value stated as 60% to 80%.1
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