Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-55

Antiretroviral therapy

• Incidence of hyperglycemia/diabetes: 0.5% • Highly active antiretroviral therapy ( HAART ) for the treatment of HIV infection, increases the risk of diabetes and may cause hyperglycemia in people with diabetes. o Protease inhibitors (atazanavir, darunavir, saquinavir, ritonavir) o Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (stavudine, zidovudine, didanosine) • Mechanism: Decrease insulin sensitivity and increase insulin resistance by interfering with GLUT-4 mediated glucose transport. • Other risk factors, such as hepatitis C infection and central obesity, can also increase insulin resistance and reduce insulin secretion. • Routine venous screening of FBG and random PG should be done at diagnosis of HIV, prior to the initiation of HAART and every 3- 6 months. Statins such as atorvastatin, rosuvastatin, simvastatin (vs pravastatin) can cause hyperglycemia. Increased risk is associated with the dose, duration of treatment and BMI. • Mechanism: Decrease insulin secretion and action. • Incidence of hyperglycemia/diabetes: 30%. • Used in the treatment of acromegaly and Cushing’s disease (pasireotide, octreotide, lanreotide). • Mechanism: Inhibits insulin and glucagon secretion. • Incidence of hyperglycemia/diabetes: 10-50%. • Post renal transplant immunosuppressant agents, such as sirolimus and • Incidence of hyperglycemia/diabetes: 9-12%. • • Incidence of hyperglycemia/diabetes: 20-36%. • Imatinib and nilotinib are new cancer treatments associated with both hyperglycemia and hypoglycemia. • Mechanism: Increase insulin resistance. • Alcohol can increase the risk of hypoglycemia in people taking sulfonylureas and/or insulin. o The hypoglycemic effect can be delayed up to 24 hours post-consumption. tacrolimus, can cause significant hyperglycemia. • Mechanism: Decreases insulin secretion/action.

Statins

Somatostatin analogues

mTOR inhibitors

Tyrosine Kinase Inhibitors

Alcohol