**9. Drugs induced hyperglycemia and DM**

Many pharmacologic and chemical agents can predispose, induce or precipitate hyperglyce‐ mia in normal subjects with high risk of T2DM or patients with IGT and DM. The individual effect of each agent could be weak or strong and subsequently the new glycemic state will be variable from transient to permanent. There are many mechanisms to induce diabetes by interfere with insulin production or secretion (e.g. Beta- Blockers), block insulin action (e.g. Steroids), interfere with both insulin secretion and action (e.g. Thiazides), and finally increase blood glucose using mechanisms independent of insulin's actions (e.g. Nicotinic acid) [165].

Table 2 shows the most common drugs that used in clinical practice with the mechanism of each drug or group.



**(Quinolone group)**

variable from transient to permanent. There are many mechanisms to induce diabetes by interfere with insulin production or secretion (e.g. Beta- Blockers), block insulin action (e.g. Steroids), interfere with both insulin secretion and action (e.g. Thiazides), and finally increase blood glucose using mechanisms independent of insulin's actions (e.g. Nicotinic acid) [165].

Table 2 shows the most common drugs that used in clinical practice with the mechanism of

Avoided in patients with DM and patients at risk of hyperglycemia. Use small dose if

Indapamide does not interfere with blood sugar control in T2DM but higher doses that cause potassium loss may cause

Loop diuretics have been reported to reduce glucose control to a lesser extent

Risk of hyperglycemia is more in patients with obesity, age, ethnic status, and certain neuropsychiatric conditions [173].

The risk of hyperglycemia is increased in patient on B-blocker and thiazide diuretics

[180].

requires [167, 168].

deterioration.

than Thiazides [168].

**Drugs Mechanisms Notes**

Receptor.

[170,171].

Olanzapine Wight gain [172, 173] and adiposity [174]

[176].

Decreases insulin release by hypokalemia [167,168] and down regulation of PPARγ

In hypertensive elderly on Thiazide but without DM, each 0.5meq/L reduction in serum potassium was associated with 45%

higher risk of new DM [169].

Sympathetic stimulation [175].

Increase fasting glucose [178].

Decrease insulin action [173] and increase IR

Potential Individual Polymorphisms in the leptin gene and leptin receptor gene to antipsychotic induced obesity [177].

Increases aldosterone release and IR

each drug or group.

80 Treatment of Type 2 Diabetes

**Thiazide and thiazide like drugs.** Chlorothiazide Chlorothalidone Hydrocholorthiazide

\*Spironolactone does not cause IGT even at high

**Atypical antipsychotics**

**Intermediate risk** Paliperidone Quietiapine Resperidone

Aripiprazole Ziprasidone

Idapamide Methyclothiazide Metolazone

dosage [167].

**High risk** Clozapine

**Low risk**

Unknown Iloperidone

**Β- blockers** Atenolol Metoprolol Propranolol



**Table 2.** A modified and updated table of mechanisms of drugs induced hyperglycemia [166].
