LETTER
Didanosine-induced Disorders of Glucose Tolerance
Helmut Albrecht;
Hans-Jürgen Stellbrink; and
Keikawus Arastéh
15 November 1993 | Volume 119 Issue 10 | Page 1050
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.
1. Pandit MK, Burke JB, Gustafson AB, Minocha A, Peiris AN. Drug-induced disorders of glucose tolerance. Ann Intern Med. 1993; 118: 529-39.
2. Seidlin M, Lambert JS, Dolin R, Valentine FT. Pancreatitis and pancreatic dysfunction in patients taking DDI. AIDS. 1992; 6:831-5.
3. Bouvet E, Casalino E, Prevost MH, Vachon F. Fatal case of 2',3'-dideoxyinosine-associated pancreatitis (Letter). Lancet. 1990; 336: 1515.
4. 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.
5. Lai KK, Gang DL, Zawacki JK, Cooley TP. Fulminant hepatic failure associated with 2',3'-dideoxyinosine (ddI). Ann Intern Med. 1991; 115:283-4.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
References
Article
