Screening Patients for Drug-Induced Hyperglycemia

 

Medications associated with drug-induced hyperglycemia include:

(1) protease inhibitors

(2) atypical antipsychotic agents (clozapine, risperidone, olanapine, quetiapine)

(3) thiazide diuretics

(4) beta-blockers

 

Protocol:

(1) Determine the baseline fasting plasma glucose concentration prior to initiating therapy.

(2) Determine if the patient has any factors indicating a high risk for developing diabetes. NOTE: These are the same conditions listed in section 13.05.10 (American Diabetes Association 1997 Criteria for Testing) except for the addition of (a) habitual physical inactivity and (b) polycystic ovary disease.

(3) Measure fasting plasma glucose every 3-4 months during the first year of therapy.

 

Patients at high risk for developing diabetes mellitus:

(1) impaired glucose tolerance (fasting plasma glucose level >= 110 mg/dL but < 126 mg/dL)

(2) positive family history in a first degree relative for diabetes mellitus

(3) certain ethnic groups: African American, Hispanic American, Native American, Asian American, Pacific Islander

(4) obesity (BMI >= 27 kg per square meter, or >= 20% above desired body weight)

(5) habitual physical inactivity

(6) hypertension (blood pressure >= 140/90 mm Hg)

(7) low high density lipoprotein (HDL) cholesterol levels (<= 35 mg/dL) and/or elevated triglyceride levels (>= 250 mg/dL)

(8) woman with a history of gestational diabetes

(9) woman with a history of delivering a baby weighing more than 4 kilograms (> 9 pounds)

Finding from Screening Protocol	Subsequent Glucose Testing Frequency For Duration of Therapy
diabetes mellitus	often (according to diabetic management)
impaired glucose tolerance	every 6 months
other factors indicating high risk	every 6 months
normal fasting plasma glucose	every 12 months