The most recent expert consensus on the management of pasireotide-induced hyperglycemia in patients with acromegaly recommended incretin-based drugs (DPP-4 inhibitors in patients at low cardiovascular risk and GLP-1 RAs in patients at high cardiovascular risk) as an alternative to first-line monotherapy with metformin, emphasizing the need for early dual therapy with proven effects on cardiovascular and renal outcomes (78). This evidence concerns the gene GLP1R and Hyperglycemia.