Impact of Drugs on Diabetes Risk and Glycemic Control

Abstract

A variety of pharmacological agents affect glucose homeostasis resulting in hyperglycemia, thus predisposing to or precipitating diabetes, when pre-existing risk factors are present. Drug-induced hyperglycemia is often benign and reversible within days with some drugs but may take longer if it is secondary to weight gain or peripheral insulin resistance. Drug-induced hyperglycemia can also implicate an increased risk of microvascular and macrovascular complications, infections, metabolic coma, and even death.

Patients showing factors predisposing to the development of diabetes mellitus (sedentary lifestyle, overweight or obesity, impaired fasting glucose or glucose intolerance, family history of diabetes, history of vascular disease, gestational diabetes, or at least one risk factor for metabolic syndrome) are at particular risk of drug-induced hyperglycemia, as some drugs can worsen pre-existing insulin resistance or pancreatic dysfunction. Thus, these risk factors should be considered before initiating drugs with potentially disturbing effects on glycemic control; moreover, efforts should be made to identify and closely monitor patients receiving drugs that are known to induce hyperglycemia. Possible mechanisms of drug-induced hyperglycemia include alterations of insulin secretion and sensitivity, direct cytotoxic effects on pancreatic cells, and increase in glucose production. Several potential strategies may be used to counteract hyperglycemia, first of all lifestyle intervention, but also a dose reduction, particularly for agents that exhibit a dose-dependent effect on glycemia. However, the discontinuation of the incriminated drug, when possible, is the best option to reverse drug-induced hyperglycemia. The time needed to improve or return to baseline glycemia generally depends on the offending drug.