• Multiple epidemiologic studies show strong relationship between these two diseases
• Type 2 Diabetes is being considered a plausible risk factor for development of Alzheimer's
• These diseases also share clinical and biochemical features suggesting common pathogenic mechanisms

Shares same risk factors as T2DM:

1. HTN
2. Hyperlipidemia
3. Family History
4. History of GDM
5. Obesity
6. Physical Inactivity

• Change offending agent if possible
• Drug therapy is typically Metformin + SU or Insulin

1. Glucocorticoids
2. Anti-Psychotics (Clozapine, Olanzapine, Aripiprazole, Ziprasidone)
3. Nucleoside Reverse Transcriptase Inhibitors
4. Human Growth Hormone

Less common:

1. Beta-agonists
2. Beta Blockers
3. Diuretics
4. Megestrol Acetate
5. Niacin

Type 2 Drug Induced Diabetes

• High doses and long term use increase risk
• Increases gluconeogenesis, increases insulin resistance, increases weight gain
• Much lower incidence for inhaled products
• May account for > 50% of all DID

• Sedentary lifestyle and poor food choices are components of psychosis - a risk factor for diabetes
• Weight gain does not appear to be dose related
• Different agents have different weight profiles (Clozapine>Olanzapine>Aripiprazole>Ziprasidone)
• Hyperglycemia can occur regardless of weight gain status
• Most weight gain is fat, not muscle or water (compliance issues)

Type 2 Drug Induced Diabetes

• Increase insulin resistance, increase weight gain
• Rarely permanent due to concurrent pancreatitis

Type 2 Drug Induced Diabetes

• Increase insulin resistance
• Increase weight gain

Drug Induced Diabetes Mimicking Type 1

• often concurrent with pancreatitis
• may be irreversible
• directly toxic to pancreatic beta cells

Drug Induced Diabetes Mimicking Type 1

• decreased insulin secretion with or without beta cell death
• difficult to differentiate from steroid-induced diabetes

Drug Induced Diabetes Mimicking Type 1

• less common than with tacrolimus
• less likely irreversible than with tacrolimus

Drug Induced Diabetes Mimicking Type 1

• Rarely occurs
• Reversible

Drug Induced Diabetes Mimicking Type 1

• Rare, but irreversible beta-cell death due to antibody formation

Drug Induced Diabetes Mimicking Type 1

• unknown mechanism (fast onset with insulinopenia)
• reversible
• cipro can inhibit glyburide metabolism and cause hypoglycemia

1. Obtain baseline FPG before starting agents likely to cause DID
2. Monitor FPG again at 1 month and q 3-6 months thereafter
3. Monitor body weight at each visit - greater than 5 kg weight gain is a strong risk regardless of changes in FPG
4. Inquire about symptoms of hyperglycemia at each visit - symptoms often lag after FPG

Drug Induced Hypglycemia

• short-term insulin spike ante pancreatic failure (insulin dump)

Drug Induced Hypglycemia

• but only in little kids (< 2 years) or in rare cases of extreme overdose (suicide attempts)