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  • Title: [Drug-induced diabetes].
    Author: Schatz H.
    Journal: Verh Dtsch Ges Inn Med; 1987; 93():517-26. PubMed ID: 2894732.
    Abstract:
    A carbohydrate disturbance or diabetogenic effect may occur even in people with normal metabolism as an undesired side effect with a great number of drugs. According to present nomenclature a distinction should be made between a "decrease of glucose tolerance" and the appearance of a (manifest) "diabetes mellitus." Instead the term "borderline diabetes" is often used in American literature. Particularly with already existing glucose tolerance disturbances, or hereditary disposition, a further deterioration can lead to diabetes mellitus that may not always disappear after discontinued use of the drug. In this context, the glucocorticoids, the saluretics and the oral contraceptives have special clinical interest. In a table are listed several drugs having a minor, or only sporadically observed, or questionably unfavorable influence on glucose tolerance. Some contain diabetogenic toxins and chemical substances that are used for experimental diabetes inducement (in animals). Extensive literature concerning the influence of female sexual hormones or oral contraceptives on the carbohydrate metabolism seems contradictory. Several mechanisms are discussed: peripheral insulin resistance, increased secretion of growth hormones and insulin, increased peripheral insulin decomposition, and inhibition of glucose decomposition via the pentose-phosphatic shunt. Glucose tolerance disturbances caused by oral contraceptives are described by some authors as occurring in 25% to 75% of all cases. Other authors found no or only rarely such an effect. The composition of the test group, the kind of ovulatory inhibitor, and the length of usage period evidently play a great role. Earlier, the estrogens, especially for higher dosages, were attributed a diabetogenic effect. However, lately the gestagens have come more to the fore. After many years of pill usage, a greater incidence of pathological glucose tolerance was registered for combination than for sequential preparations. It would appear that for (younger) diabetics (without late complications) that the most suitable contraceptive should consist of a sequential preparation with a low estrogen admixture (below 50 mg). Which gestagen and which dosage would result in the smallest long-term effect on glucose tolerance remains to be clarified.
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