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2023 Sep 15;44(5):753-778

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The second generation somatostatin analog pasireotide has been shown to induce impaired glucose tolerance, overt diabetes or worsen glycemic control especially in patients with pre-existing disturbed glucose metabolism (52)

Together this phenomenon is collectively referred to as the gray market. This gray market is not subject to the quality control regulations that govern the pharmaceutical industry, and testing conducted on a range of peptides including MOTS-c, BPC-157, TB-500, and CJC-1295 by The New Yorker in April showed that many were impure or contained less than the advertised dose