Diabetes-Severe Blood Sugar Swings Among Diabetics Taking
Fluoroquinolones
Study Examines Risk of Severe Blood Sugar Swings Among
Diabetics Taking Fluoroquinolones
Aug. 15, 2013 — Diabetic patients
taking oral
fluoroquinolones, a frequently prescribed class of antibiotics, were found
to have a higher risk of
severe blood sugar-related problems than diabetic patients taking other
kinds of antibiotics, according to a recent study from Taiwan published in Clinical
Infectious Diseases. The increased risk was low -- hyperglycemia (high
blood sugar) or hypoglycemia (low blood sugar) related to the drugs occurred in
fewer than one in 100 patients studied -- but clinicians should consider the higher risk when treating
diabetic patients with fluoroquinolones, especially moxifloxacin, and
prescribe them cautiously, the study's authors concluded.
Increased use of these drugs,
commonly used to treat such illnesses as urinary tract infections and community-acquired
pneumonia, has raised concerns about rare but severe adverse effects,
including tendon rupture
and heart arrhythmia. Previous studies have also indicated a
relationship between fluoroquinolones and severe glucose-related abnormalities,
known as dysglycemia,
which includes hyperglycemia
or hypoglycemia. Severe blood sugar swings can lead to serious health problems,
including irreversible
brain damage or even death. In 2006, one drug from the fluoroquinolone
class, gatifloxacin,
was withdrawn from the U.S. market due to the risk of blood sugar abnormalities.
To assess the risk of blood sugar
swings in diabetic patients using specific fluoroquinolones, a team of
researchers, led by Mei-Shu Lai, MD, PhD, at National Taiwan University in
Taipei, conducted a population-based cohort study of approximately 78,000
people with diabetes in Taiwan from January 2006 to November 2007.
Using the claims database for
Taiwan's national insurance program, the researchers analyzed data for diabetic
outpatients who had received a new prescription for an antibiotic from one of
three different classes of antibiotics: fluoroquinolones (levofloxacin,
ciprofloxacin, or moxifloxacin); second-generation cephalosporins (cefuroxime,
cefaclor, or cefprozil); or macrolides (clarithromycin or azithromycin). The
study's authors then looked for any emergency department visits or
hospitalizations for dysglycemia among these patients within 30 days of the
start of their antibiotic therapy.
Diabetics
using oral fluoroquinolones faced greater risk of severe blood
sugar swings than diabetic patients using antibiotics in other classes,
the researchers found. The risks varied according to the specific
fluoroquinolone the patients were using: The absolute risk, or incidence, of hyperglycemia per 1,000 people
studied was 6.9 for moxifloxacin, 3.9 for levofloxacin, and 4.0 for ciprofloxacin. The absolute risk of
hypoglycemia was 10.0 for moxifloxacin, 9.3 for levofloxacin, and
7.9 for ciprofloxacin.
(By comparison, among diabetic
patients taking antibiotics in the macrolides class, the absolute risk of
hyperglycemia was lower, at 1.6 per 1,000, and 2.1 per 1,000 among those taking
antibiotics in the cephalosporin class; for hypoglycemia, the absolute risk per
1,000 was 3.7 for macrolides and 3.2 for cephalosporins, respectively.)
"Our results identified
moxifloxacin as the drug associated with the highest risk of hypoglycemia,
followed by levofloxacin and ciprofloxacin," the study's authors wrote.
"Other antibiotics should be considered if dysglycemia is a concern, such as a beta lactam or macrolide,"
noted Dr. Lai.
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