Didanosine-induced Disorders of Glucose Tolerance
Authors: Helmut Albrecht
Journal: Annals of Internal Medicine (1993)

Letters15 November 1993Didanosine-induced Disorders of Glucose ToleranceHelmut Albrecht, MD, Hans-Jrgen Stellbrink, MD, and Keikawus Arasth, MDHelmut Albrecht, MDSearch for more papers by this author, Hans-Jrgen Stellbrink, MDSearch for more papers by this author, and Keikawus Arasth, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-10-199311150-00017 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their review, Pandit and colleagues [1] compiled a comprehensive list of drugs capable of inducing disorders of glucose tolerance. Some drugs mentioned, such as pentamidine, trimethoprim-sulfamethoxazole, corticosteroids, dapsone, rifampin, ganciclovir, and octreotide, are commonly used for the treatment of patients with human immunodeficiency virus (HIV) infection. Didanosine (ddI), an increasingly used antiretroviral agent, can also induce hyperglycemia and may occasionally cause overt diabetes mellitus.The pancreatic toxicity of ddI is well established [2-4]. Some authors have reported reversible hyperglycemia or development of diabetes with and without concurrent elevation of amylase or lipase levels in a substantial proportion of their patients treated with ddI [3, 4].After having observed the consecutive development of diabetes and pancreatitis in one of our ddI-treated patients, we prospectively followed 12 patients who at the beginning of ddI treatment had normal glucose tolerance (venous plasma glucose concentrations <200 mg/dL after challenge with 75 g of glucose). Six developed impaired glucose tolerance (glucose levels >200 mg/dL after glucose challenge), which reversed on stopping ddI.We and others [3] have observed that alterations in glucose metabolism may precede the onset of pancreatitis. We hope that future prospective studies clarify whether regular screening of ddI-treated patients for new manifestations of alterations of glucose tolerance contributes to the identification of those at risk for the development of potentially fatal pancreatitis. Until this issue has been resolved, ddI-treated patients who develop altered glucose metabolism should be monitored closely for manifestations of pancreatitis. Overt diabetes could indicate pancreatic injury due to ddI and probably should lead to the drug's discontinuance.Because ddI has also been reported to cause substantial hepatotoxicity with subsequent development of hypoglycemia [5], it should be included in future reviews of drug-induced disorders of glucose tolerance.References1. Pandit MK, Burke JB, Gustafson AB, Minocha A, Peiris AN. Drug-induced disorders of glucose tolerance. Ann Intern Med. 1993; 118: 529-39. Google Scholar2. Seidlin M, Lambert JS, Dolin R, Valentine FT. Pancreatitis and pancreatic dysfunction in patients taking DDI. AIDS. 1992; 6:831-5. Google Scholar3. Bouvet E, Casalino E, Prevost MH, Vachon F. Fatal case of 2,3-dideoxyinosine-associated pancreatitis (Letter). Lancet. 1990; 336: 1515. Google Scholar4. Nelson M, Moyle G, Reddy J, Nield J, Mitter A, Gazzard B. Toxicity of dideoxyinosine (DDI) in zidovudine intolerant patients (Abstract). Int Conf AIDS. 1991; 7:209. Google Scholar5. Lai KK, Gang DL, Zawacki JK, Cooley TP. Fulminant hepatic failure associated with 2,3-dideoxyinosine (ddI). Ann Intern Med. 1991; 115:283-4. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByImpact of Drugs on Diabetes Risk and Glycemic ControlImpact of Drugs on Diabetes Risk and Glycemic ControlImpact of Drugs on Diabetes Risk and Glycemic ControlImpact of Drugs on Diabetes Risk and Glycemic ControlDrug-Induced Hyperglycaemia and DiabetesDrug-Induced Hyperglycemia and Diabetes MellitusHigher Risk of Hyperglycemia in HIV-Infected Patients Treated with Didanosine Plus TenofovirDrug-induced diabetes mellitusDas Modell des kundenorientierten Wissensmanagements für IndustriegüterunternehmenHyperglycemia associated with protease inhibitors in HIV-1-infected patientsAcute pancreatitis in human immunodeficiency virus–infected patients: a reviewSevere Hyperglycemia in an HIV Clinic: Preexisting Versus Drug-Associated Diabetes MellitusDiabète sucré médicamenteux au cours de l'infection par le VIH. A propos de cinq casTHE PANCREAS IN AIDSClinical toxicity of antiretroviral nucleoside analogs10 Pancreatic lesions in HIV-infected patients 15 November 1993Volume 119, Issue 10Page: 1050KeywordsDrugsForecastingGlucoseGlucose metabolismGlucose toleranceHyperglycemiaPancreatitisPatientsProspective studiesToxicity Issue Published: 15 November 1993 CopyrightCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...