Preface

More than 29 million Americans currently have diabetes and approximately 86 million have prediabetes. People with diabetes often also require medications for several comorbid conditions (including hypertension, dyslipidemia, depression, heart disease, pain syndromes). A vast literature abounds, however, on the potential adverse effects 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 hormone replacement, contraception, infections) might worsen glycemic control in diabetic patients or trigger diabetes in others. These concerns influence therapeutic decisions in a manner that sometimes emphasizes avoidance of possible dysglycemia over effective control of the comorbid conditions. The same concerns may also weigh against the otherwise appropriate use of necessary medications.

The purpose of this concise book is to provide clinicians with actionable knowledge regarding the effects of various medications on glucose regulation and diabetes risk. Beginning with a brief overview of diabetes pathophysiology, the different drugs have been organized by class, and the scientific 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, bronchodilators, sex hormones (androgens, estrogens, and oral contraceptives), glucocorticoids, lipid-lowering agents, nonsteroidal anti-inflammatory drugs, acetaminophen, and thyroid hormone. Although less widely prescribed than the foregoing list, atypical antipsychotics, HIV antiretrovirals, immunomodulatory agents used in transplant medicine, gonadotropin-releasing hormone analogs, and human growth hormone also have 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, because of the possible intersection between these addictive agents and the global diabetes epidemic, an account of the growing link between the use of recreational drugs (alcohol, nicotine, marijuana, opioids, cocaine, amphetamine-like drugs and other psychostimulants) and glucose abnormalities has been included.

With some medications, the data presented should help debunk myths, clarify misperceptions, and provide reassurance to practicing clinicians. Wherever the evidence supports increased diabetes risk, clear suggestions are given on how to reduce the risk. Also covered in this book are diabetes management guidelines for special situations, including new-onset diabetes after transplant and TPN-induced hyperglycemia. The final chapter provides a general approach to the prevention or attenuation of diabetes risk, focusing on risk stratification, lifestyle modification, and a critical appraisal of the medications that have been demonstrated, in clinical trials, to prevent or delay diabetes. Also introduced is the emerging concept of diabetes pharmacoprophylaxis in high-risk individuals receiving treatment with potentially diabetogenic agents.

The knowledge gained from reading this book should enable clinicians to become well informed regarding the impact of a wide variety of commonly used medications on glucose homeostasis and the risks of drug-induced diabetes or exacerbation of preexisting diabetes. With such knowledge, clinicians will be better positioned to design and select therapeutic regimens that embody the best risk–benefit profile with regard to glycemia and concurrent management of the primary or comorbid conditions.