MD Conference Express ADA 2011 - (Page 25)

S E L E C T E D U P D A T E S I N D Y S G LY C E M I A n Risk of Drug-Induced Dysglycemia Typically Outweighed by Benefits Written by Lori Alexander A wide variety of drugs can “tip the balance of glucose homeostasis,” leading to dysglycemia, said Charles D. Ponte, PharmD, DPNAP, FAPhA, FASHP, FCCP, West Virginia University School of Pharmacy, Morgantown, West Virginia, USA. But, the risks and benefits of these drugs should be carefully considered, as their benefits may outweigh an increased risk of diabetes. Dr. Ponte listed several drugs that cause either hyperglycemia or hypoglycemia, noting that the list was in no way complete (Table 1). Drugs alone may alter blood glucose levels, but in many cases, the drugs can interact with a variety of patient factors that could, for example, result in altered drug metabolism or some other consequence, leading to hyperglycemia or hypoglycemia. Among the risk factors are a history of metabolic syndrome or prediabetes, older age, polypharmacy, and reduced carbohydrate intake. The consequences of drug-induced dysglycemia may be no different than the morbidity and mortality that are caused by hyperglycemia and hypoglycemia from any cause [Dang DK, Pucino F, Ponte CD, Calis KA. Glucose and insulin dysregulation. In: Tisdale JE, Miller DA. Drug-Induced Diseases. 2nded. Bethesda, MD: American Society of Health-System Pharmacists, Inc; 2010]. Table 1. Examples of Drugs that Cause Dysglycemia. Hyperglycemia • • • • • • Atypical antipsychotics Cyclosporine Diazoxide Glucocorticoids Niacin Oral contraceptives Hypoglycemia • • • • • • β-blockers Ethanol Insulin Pentamidine Salicylates Sulfonylureas Before determining that dysglycemia is drug-induced, clinicians should consider what other conditions may have a role in causing abnormal glucose levels. The differential diagnosis includes diabetes, pancreatitis, cirrhosis, Addison disease, alcoholism, glycogen storage disease, and others. Some drugs of particular concern in the diabetes setting are two commonly used drugs— thiazide diuretics and statins—and antipsychotic agents, all of which have been associated with an increased risk of diabetes. Thiazide Diuretics Thiazide-induced dysglycemia has generated a long-standing debate, said Michael Ernst, PharmD, BCPS, FCCP, University of Iowa, Iowa City, Iowa, USA. Early researchers warned against the use of the drugs, but a later study showed that while thiazide was associated with a 40% increased risk of hyperglycemia, almost all antihypertensive drugs were associated with an increased risk (Figure 1) [Gurwitz JH et al. Ann Intern Med 1993]. A combination of antihypertensive agents, one of which was a thiazide, was associated with the greatest risk. Peer-Reviewed Highlights from the Peer-Reviewed Highlights from the American Diabetes Association 71st Annual Scientific Sessions 25  http://www.mdconferencexpress.com http://scientificsessions.diabetes.org

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