Review Article Integrative Clinical Medicine Int Clin Med, 2017 doi: 10.15761/ICM.1000103 Volume 1(1): 1-8 ISSN: 2515-0219 Medications afecting glycemic control Ghazwa B Korayem* Pharmacy Practice Resident, College of Pharmacy, University of Arizona, Banner University Medical Center, Tucson, AZ, USA Abstract Introduction: Review non-diabetes management medications that are commonly associated with either serious hyper- or hypoglycemia, or both, outline their mechanisms, and provide strategies for limiting these undesirable glycemic efects. Methods: Literature search of Pub-Med for studies in which drugs induced hyperglycemia or hypoglycemia. Te primary outcome for this review was the incidence and occurrence of hyperglycemia and or hypoglycemia Results: Both hyperglycemia and hypoglycemia are associated with negative outcomes. Blood glucose variation was signifcantly associated with mortality in non- diabetic greater than diabetic patients. Medications may contribute to this glycemic variation manifested as either hyperglycemia or hypoglycemia. Many medications have been associated with aggravating hyperglycemia in diabetes mellitus patients, causing new hyperglycemia or outright diabetes in previously non-diabetic individuals. Steroids, immunosuppressive agents, antipsychotics and many other medications are commonly associated with hyperglycemia. On the other hand, hypoglycemia is an uncommon adverse efect associated with some antimicrobials and other medications. Te risk may be increased, however, when such medications are used concomitantly with anti-diabetic agents. Benefts of these medications associated with hyper- or hypoglycemia may ofset the potential adverse efects of abnormal glycemic control making overall management of the patient a challenge. Conclusion: Hyperglycemia, hypoglycemia, and glucose variation have been shown to contribute to negative outcomes. Terefore, it is imperative for clinicians to be aware of medications that may adversely afect glucose control. Withholding these medications may be justifed in certain situations; however, any decision to avoid a medication based on glycemic efects must be carefully weighed against their beneft as well as the risks and benefts of alternative therapies. Correspondence to: Ghazwa B Korayem, Pharmacy Practice Resident, College of Pharmacy, University of Arizona, Banner University Medical Center, Tucson, AZ , 0202, 1295 N, Martin Ave, AZ 85721, USA, Tel: +1(520)694-2265; E-mail: korayem@pharmacy.arizona.edu Key words: hyperglycemia, hypoglycemia, medications, diabetes, steroids, glucose and insulin Received: April 03, 2017; Accepted: May 01, 2017; Published: May 04, 2017 Introduction Hyperglycemia, hypoglycemia and blood glucose variability are associated with negative outcomes, including increased mortality in both individuals with or without diabetes mellitus (DM) [1-3]. Some medications alter glycemic hemostasis which manifests as either hyperglycemia or hypoglycemia [2]. Inconsistent caloric intake, stress, infections, organ failure, advanced age, intensive inpatient insulin regimens or inadequate glycemic therapy and polypharmacy also contribute to glucose alterations [4,5]. Terefore, controlling blood glucose (BG) in hospitalized or acutely ill patients is a challenge. Hormones involved in glucose hemostasis, such insulin, glucagon, catecholamines (CA), growth hormone, and cortisol, are also afected by some medications. Tis article aims to review non-DM medications medications that are commonly associated with either serious hyper- or hypoglycemia, or both, and discusses their mechanisms, as well as providing strategies for limiting or avoiding the undesirable glycemic efects. Hyperglycemia Drug-induced diabetes is a global issue that is frequently overlooked. Medications can either aggravate diabetes-associated hyperglycemia, or may cause new hyperglycemia episodes or outright DM in previously non-DM individuals. Te American Diabetes Association (ADA) classify drug induced DM under “monogenic diabetes syndromes,” a specifc type of DM that is drug- or chemical-induced [6]. Older age, high body mass index, or family history may increase the risk of medication induced hyperglycemia and impaired glucose tolerance (IGT) [5]. Regardless of the cause, the frst step in managing patients with IGT, hyperglycemia or DM, should be preventing or mitigating modifable risk factors through lifestyle modifcation including weight loss, maintaining a healthy diet, adequate physical activity and patient education. Clinical judgment along with continuous assessment of the patient’s clinical status, illness severity, nutritional status, and concomitant medications potentially afecting glucose concentration should be incorporated into decisions to avoid, hold or continue therapy [7]. If DM develops, it may be appropriate to consider management with anti-diabetic agents. Atypical antipsychotic Second generation or atypical antipsychotics (AAP) are widely prescribed for the management of schizophrenia, other psychotic disorders and conditions with severe behavioral disturbance. Both typical antipsychotic (TAP) and AAP use may lead to metabolic abnormalities including hyperglycemia [8]. In addition, it should be recognized that schizophrenia itself may represent an inherent risk for developing type 2 DM [9]. Increased weight and concomitant use of valproic acid, selective serotonin reuptake inhibitors, or buspirone may also exacerbate hyperglycemia [10]. Antipsychotic-associated hyperglycemia occurs early in therapy but risk of new onset diabetes