The results showed that diabetic patients treated with metformin had a lower risk of developing PC compared to those who did not receive metformin, whereas diabetic patients who received insulin therapy had a higher risk of PC [69]. Incretin-based therapies glucagon-like peptide-1 (GLP1) analogs, and inhibitors of dipeptidyl peptidase-IV, the enzyme that metabolizes GLP1, have shown an association with acute pancreatitis [8]. Here, INS is linked to pachyonychia congenita.