Diabetes is a disease in which the body is unable to remove glucose, a type of sugar, from the blood. Normally, when levels of glucose in the blood rise the pancreas secretes a hormone called insulin that causes fat and muscle cells to absorb glucose and take it out of the blood. In type II diabetes, these cells become resistant to the effect of insulin, a condition known as insulin resistance. Any medication that can cause insulin resistance can also cause diabetes.
Glucocorticoids
Glucocorticoids are medications that are similar to cortisol, a hormone naturally secreted by the adrenal glands. Glucocorticoids are used to treat diseases where excess or inappropriate inflammation is causing problems, such as asthma, lupus and rheumatoid arthritis. Common examples of glucocorticoids include prednisone, dexamethasone and solumedrol. All of these medications increase insulin resistance, which can lead to diabetes.
Protease Inhibitors
Protease inhibitors, or PIs, are used to treat HIV infection and occasionally certain other viral diseases, such as hepatitis C. A side effect of PIs is a shift in the location of fat storage in the body away from the arms and legs and towards the abdomen. Along with this shifting of fat, PIs increase insulin resistance. It is not clear whether this increase is a result of the fat shifting to the abdomen, since abdominal fat is known to increase insulin resistance or whether there it is separate side effect of the PIs. Examples of PIs include lopinavir, atazanavir and saquinavir.
Atypical Antipsychotics
Antipsychotics are medications used to treat schizophrenia. Atypical antipsychotics are newer medication for this purpose that are less likely to cause movement problems than older drugs. Examples of atypical antipsychotics include clozapine, risperidone and olanzapine. The exact role that atypical antipsychotics play in diabetes is controversial. A paper published in the April 2002 issue of the "American Journal of Psychiatry" describes a study of over 38,000 patients with schizophrenia in which the rate of diabetes was significantly higher in patients treated with atypical antipsychotics than those treated with older medications. But the authors of a review article published in the February 2003 issue of the "Journal of Clinical Psychiatry" note that schizophrenics are more likely to have a family history of diabetes than non-schizophrenics, implying that the two disorders may be genetically linked. In addition, some atypical antipsychotics are known to be associated with weight gain, and weight gain is an established risk factor for type II diabetes. So it may be the weight gain, which is potentially controllable, and not the medications themselves that are causing the diabetes.
References
- Harrison's Principles of Internal Medicine; Dennis L. Kasper; 2005
- Association of Diabetes Mellitus with Use of Atypical Neuroleptics in the Treatment of Schizophrenia; American Journal of Psychiatry; MJ Semyak; 2002
- Metabolic Issues with Atypical Antipsychotics in Primary Care: Dispelling the Myth
