Medications and Diabetes Risk: Mechanisms and Approach to Risk Reduction

106 Pages·2011·0.6 MB·English

by  Samuel Dagogo-Jack

O A P N
OXFORD AMERICAN POCKET NOTES
Medications and
Diabetes Risk:
Mechanisms and
Approach to Risk
Reduction
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This material is not intended to be, and should not
be considered, a substitute for medical or other
professional advice. Treatment for the conditions
described in this material is highly dependent on the indi-
vidual circumstances. While this material is designed to
off er accurate information with respect to the subject mat-
ter covered and to be current as of the time it was written,
research and knowledge about medical and health issues is
constantly evolving, and dose schedules for medications are
being revised continually, with new side eff ects recognized
and accounted for regularly. Readers must therefore always
check the product information and clinical procedures with
the most up-to-date published product information and data
sheets provided by the manufacturers and the most recent
codes of conduct and safety regulation. Oxford University
Press and the authors make no representations or warranties
to readers, express or implied, as to the accuracy or com-
pleteness of this material, including without limitation that
they make no representations or warranties as to the accuracy
or effi cacy of the drug dosages mentioned in the material.
The authors and the publishers do not accept, and expressly
disclaim, any responsibility for any liability, loss, or risk that
may be claimed or incurred as a consequence of the use and/
or application of any of the contents of this material.
The Publisher is responsible for author selection and the
Publisher and the Author(s) make all editorial decisions,
including decisions regarding content. The Publisher and the
Author(s) are not responsible for any product information
added to this publication by companies purchasing copies of
it for distribution to clinicians.
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O A P N
OXFORD AMERICAN POCKET NOTES
Medications and Diabetes
Risk: Mechanisms
and Approach to Risk
Reduction
Samuel Dagogo-Jack, MD, FRCP
Mullins Professor in Translational Research
Professor of Medicine & Chief
Division of Endocrinology, Diabetes & Metabolism
University of Tennessee Health Science Center
Memphis, TN
1
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1
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ISBN: 978-0-19-973431-3
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MEDICATIONS AND
DIABETES RISK
DISCLOSURES
Dr. Dagogo-Jack has served as a consultant for Eli Lilly
and GlaxoSmithKline. He has also served on the speaker’s
bureaus of Merck and Sanofi -Aventis.
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MEDICATIONS AND
DIABETES RISK
PREFACE
More than 23 million Americans currently have diabetes,
and approximately 54 million have prediabetes. People with
diabetes often also require medications for several comorbid
conditions (including hypertension, dyslipidemia, depres-
sion, heart disease, and pain syndromes). Yet, a vast litera-
ture abounds on the potential adverse eff ects of numerous
medications on glucose metabolism. There is, thus, genuine
clinical concern that certain medications used for treatment
of comorbid conditions and other indications (such as hor-
mone replacement, contraception, infections) might worsen
glycemic control in diabetic patients or trigger diabetes in
others. These concerns infl uence therapeutic decisions in
a manner that sometimes emphasizes avoidance of possible
dysglycemia over eff ective control of the comorbid condi-
tions. The same concerns may also weigh against the other-
wise appropriate use of necessary medications.
The purpose of this concise book is to provide clinicians
with actionable knowledge regarding the eff ects of vari-
ous medications on glucose regulation and diabetes risk.
Beginning with a brief overview of diabetes pathophysiol-
ogy, the diff erent drugs have been organized by class, and
the scientifi c evidence for the diabetes risk and possible
mechanisms have been presented for each drug. The agents
discussed include widely prescribed medication classes:
antibiotics, antidepressants, antihypertensives, bronchodi-
lators, estrogens and oral contraceptives, glucocorticoids,
lipid-lowering agents, nonsteroidal anti-infl ammatory drugs
(NSAIDs), and thyroid hormone. Although less widely pre-
scribed than the foregoing list, atypical antipsychotics,
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OOOAAAPPPNNN
human immunodefi ciency virus (HIV) anti retrovirals,
immunomodulatory agents, and human growth hormone
have also been included because of the interest generated by
their link to diabetes risk. In addition to medications used
in ambulatory practice, this work includes a discussion of
total parenteral nutrition (TPN)-induced hyperglycemia,
which is associated with increased morbidity and mortality
among hospitalized patients. For completeness, an account
of the growing link between use of recreational drugs (alco-
hol, nicotine, cannabinoids, opioids, cocaine) and glucose
abnormalities has been included, because of the possible
intersection between these addictive agents and the growing
diabetes epidemic.
With some medications, the data presented should help
debunk myths, clarify misperceptions, and provide reassur-
ance to the practicing clinicians. Wherever the evidence sup-
ports increased diabetes risk, clear suggestions are given on
how to reduce the risk. There are also diabetes management
guidelines for special situations, including new-onset diabetes
after transplant (NODAT) and TPN-induced hyperglycemia.
The fi nal chapter provides suggestions for a general approach
to the prevention or attenuation of diabetes risk, focusing on
risk stratifi cation, lifestyle modifi cation, and the emerging
concept of diabetes “pharmacoprevention” in high-risk persons
receiving treatment with potentially diabetogenic agents.
This book should serve two essential functions—to enable
clinicians to confi dently prescribe therapeutic regimens that
embody the best risk–benefi t profi le with regard to glyce-
mia, and to equip them with the know-how for preventing
and managing drug-induced hyperglycemia.
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MEDICATIONS AND
DIABETES RISK
TABLE OF CONTENTS
1 Pathophysiology of Type 1 and Type 2 Diabetes 1
2 General Mechanisms of Medications and
Diabetes Risk 8
3 Steroids and Immunomodulatory Agents 14
4 Antihypertensive Agents 26
5 Catecholamines, (cid:2)-Adrenergic Agonists, and
Bronchodilators 33
6 Lipid-lowering Drugs 35
7 Antimicrobial Drugs 40
8 Atypical Antipsychotic and Antidepressant
Agents 47
9 Recreational Drugs 56
10 Miscellaneous Agents 59
11 General Approach to Risk Reduction 66
References 70
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