Which diabetes medication is contraindicated in a patient with chronic pancreatitis?

Dulaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that is contraindicated in patients with a history of chronic pancreatitis due to the potential increased risk of acute pancreatitis associated with this class of drugs. The mechanism by which GLP-1 agonists can exacerbate or precipitate pancreatitis is not fully understood, but their effects on increasing endogenous insulin secretion and inhibiting glucagon are believed to play a role. Therefore, in patients with chronic pancreatitis, using dulaglutide could lead to the worsening of their condition or potentially trigger an acute episode of pancreatitis.

In contrast, the other medications listed do not carry the same contraindication in chronic pancreatitis patients. Glipizide, a sulfonylurea, works by stimulating insulin release from the pancreatic beta cells, while insulin lispro is a rapid-acting form of insulin that can be used safely in these patients. Metformin is often the first-line treatment for type 2 diabetes and does not have a direct contraindication in patients with chronic pancreatitis, although caution is advised in those with renal impairment. Thus, dulaglutide's association with an increased risk of pancreatitis makes it the medication that is contraind