We’re in the middle of a pandemic, but you already knew that. We’re also in the middle of an epidemic. It has been going on for decades and the long-term health consequences could be even more grave that those from the coronavirus. This world-wide problem is killing many millions of people, slowly but surely. Could some of our most popular drugs be partly responsible for the diabetes epidemic?
How Could Drugs Be Responsible for the Diabetes Epidemic?
According to the American Diabetes Association, diabetes affects 34 million children and adults in the US. Over 7 million people have this metabolic disorder but may not know it. Tens of millions more have prediabetes.
Experts call type 2 diabetes a global health crisis because it is increasing at an alarming rate. Overall, this metabolic disorder contributes to heart disease and other chronic health conditions. Type 2 diabetes tends to run in families. Insulin resistance, in which the cells fail to respond properly to this hormone by taking in sugar from the blood stream, is the hallmark of type 2 diabetes. Frequently, this is also the first stage of the disease.
What Is Behind Type 2 Diabetes?
Public health authorities often blame eating behavior, a sedentary lifestyle and excess fat around the internal organs as the prime culprits behind this disease. There’s no doubt that lifestyle factors are a major contributor to this epidemic. What is rarely mentioned, however, is the number of medicines that can also contribute to the development of type 2 diabetes.
Which Pills Raise the Risk of Type 2 Diabetes?
PPIs for Acid Reflux:
Some of the most widely prescribed pills in the world raise blood sugar levels and are associated with a diagnosis of diabetes. The latest to join this club are popular acid-suppressing drugs called proton pump inhibitors or PPIs.
Pharmacy experts estimate that more than 100 million prescriptions are filled each year around the world. In the US alone, more than 20 million people take medications like esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec).
A study in the journal Gut (Sept. 28, 2020)
“…found that regular PPI use was associated with a 24% higher risk of type 2 diabetes. The risk of diabetes was likely to increase with the duration of PPI use and to decrease with the time stopping PPIs.”
The authors conclude:
“Regular use of PPIs was associated with a higher risk of type 2 diabetes and the risk increased with longer duration of use. Physicians should therefore exercise caution when prescribing PPIs, particularly for long-term use.”
Corticosteroids to Fight Inflammation:
Other drugs that may be contributing to the type 2 diabetes epidemic include corticosteroids like prednisone. At last count, over 10 million people are taking this drug to relieve inflammation. But it and other steroids can raise blood sugar levels and trigger diabetes. Moreover, inhaled corticosteroids used to treat lung problems like COPD (chronic obstructive pulmonary disease) may also increase the risk of type 2 diabetes (Diabetes, Obesity & Metabolism, Aug. 2020).
Are Important Heart Medicines Responsible for the Diabetes Epidemic?
Statins That Lower Cholesterol:
Every year, more than 40 million Americans take a statin such as atorvastatin, lovastatin, pravastatin, rosuvastatin or simvastatin. Such drugs lower cholesterol and help protect people with heart disease from complications. However, they can also raise blood glucose levels.
A six-year Finnish study concluded that
“Statin treatment increased the risk of type 2 diabetes by 46%, attributable to decreases in insulin sensitivity and insulin secretion” (Diabetologia, May, 2015). [We should note that the 46% increase is a relative risk. The absolute risk for new-onset type 2 diabetes was 11.2% among those on statins and 5.8% among those not taking those drugs.]
Diuretics to Control Blood Pressure:
Even commonly prescribed diuretics like HCTZ (hydrochlorothiazide) can make blood sugar levels harder to control (Hypertension, June 26, 2006). At last count, over 20 million Americans swallow this drug, usually to control hypertension.
Could Antidepressants Contribute to the Diabetes Epidemic?
An article in JAMA Internal Medicine (Feb. 2017) reported that roughly 1 in 6 Americans takes a psychiatric drug. Not surprisingly, antidepressants were at the top of the pyramid. Such drugs may be in part responsible for the diabetes epidemic.
Recently, researchers from the University of Maryland Schools of Pharmacy and Medicine collaborated to analyze medical records of 119,000 children and adolescents covered by Medicaid (JAMA Pediatrics, Dec. 2017 ). The investigators included only youngsters who had taken an antidepressant.
Those who were still taking a serotonin-type drug such as fluoxetine were roughly twice as likely to develop type 2 diabetes as those who took such a drug for only a short time. Higher doses appeared to create more risk. Other types of antidepressants did not appear linked to a higher risk for metabolic disruption.
Why Would Antidepressants Impact the Diabetes Epidemic?
Some studies suggest that SSRI medicines may interfere with the proper function of beta cells in the pancreas. Beta cells produce insulin, and when they fail, the patient develops diabetes. Although doctors have known about this effect of SSRIs for some time, they appear not to have paid it much attention.
For example, research published in the Journal of Biological Chemistry (Feb. 22, 2013) notes that:
“Long term use of SSRIs is associated with an increased risk of diabetes…Insulin resistance is a common pathological state in which target cells fail to respond to ordinary levels of circulating insulin. Individuals with insulin resistance suffer from impaired insulin action and are predisposed to developing type 2 diabetes, a 21st century epidemic…”
“In conclusion, we have demonstrated that SSRIs are potential inducers of insulin resistance, acting by directly inhibiting the insulin signaling cascade in beta cells…Given that SSRIs promote obesity and insulin resistance but inhibit insulin secretion, they might accelerate the transition from an insulin resistant state to overt diabetes. Further studies are therefore required to assess the clinical relevance of our findings and to devise effective means to block the adverse metabolic changes induced by SSRIs.”
The People’s Pharmacy Perspective:
No one should EVER stop any medication without checking with the prescriber. Medications like antidepressants, statins or diuretics may be essential. However, millions of people take selective serotonin re-uptake inhibitors (SSRIs) like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil). We suspect that few prescribers are paying attention to a possible connection with insulin resistance or type 2 diabetes. Ideally, health care professionals would weigh this possibility every time they ask you to take a pill for more than a few days.
Sometimes lowering the dose of a statin or a diuretic can diminish the impact on blood sugar levels. In other instances, the risk of diabetes may be quite small and be outweighed by the benefits of the medicine. The medical consensus on statins attributes them greater benefit than risk in this manner. The moral of this tale, though, is that health care professionals must be aware that some of the medicines they prescribe could be partly responsible for the epidemic of diabetes sweeping the globe.
To find out more about medicines that may increase your risk of type 2 diabetes as well as medications and nondrug options for controlling blood sugar, you may wish to read our eGuide to Preventing and Treating Diabetes. If you prefer to listen, you will find Show 1173: How Is Diabetes Diagnosed and Treated? of great interest.