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Drug-Related Hyperglycemia

N. Norman Chan, MRCP; Risa Osaki, MRCP; C. C. Chow, FRCP; Juliana C. N. Chan, MD, FRCP; Clive S. Cockram, MD, FRCP
JAMA. 2002;287(6):714-715. doi:10.1001/jama.287.6.711.
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To the Editor: In their Contempo Updates article about drug-induced hyperglycemia,1 Drs Luna and Feinglos did not mention glucosamine sulfate, a drug that is increasingly used in the treatment of osteoarthritis.2

By increasing glucose flux through the hexosamine biosynthetic pathway, glucosamine has been shown to induce insulin resistance in skeletal muscle.3 Furthermore, acceleration of the hexosamine pathway also inhibits glucose-induced insulin secretion, resulting in hyperglycemia.4 In a case report of a patient with disabling hypoglycemic symptoms caused by metastatic insulinoma, the use of glucosamine for osteoarthritis led to marked improvement of these symptoms.5 In industrialized countries where people are becoming increasingly overweight and thus at increased risk of osteoarthritis, the diabetogenic effect of glucosamine must be considered.


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