Hyperglycaemia induced by paracetamol

Antipyretics might occupy a narrow temporal position in aetiology of type 1 diabetes: Immunological and intestinal studies required

Geographical variance in the incidence of type 1 diabetes mellitus (T1DM) and its etiological link to viruses and gut microbiome imply causative environmental agents. Antipyretics and especially acetaminophen received some attention recently due to the associations with some autoimmune conditions and lack of studies on the mechanisms influencing the immune system. A couple of recent studies involving large cohorts have found no association between the use of acetaminophen in early childhood and seroconversion leading to T1DM (TEDDY, involving international cohort) or diagnosis of overt T1DM (Norwegian MoBa) in the follow up years. The paper gives the supplemental argumentation for the antipyretic hypothesis presented in Medical Hypotheses in 2016 that is still valid in face of the mentioned conclusions. The hypothesis assumes that critical effect of acetaminophen and possibly other antipyretics expresses itself as the immediate influence on the immune system in the unfortunate coincidence with the other environmental factors, supposedly involving feverish, new to immunity, viral infection, all creating triggering circumstances regardless of age. Young age, in this respect should be regarded as a risk factor due to immatureness of immunity. The paper discusses that antipyretics and particularly acetaminophen need more attention evaluating their possible immunity modulations during infection or through negative effects on intestinal microbiota or both.

Lethal methemoglobinemia in the invasive brown treesnake after acetaminophen ingestion

The invasive brown treesnake (Boiga irregularis) has extirpated much of Guam's native birdlife and poses significant threats to other parts of the western Pacific. Acetaminophen (APAP) is a proven lethal oral toxicant in reptiles but the physiological mechanism is unknown. The effects of a lethal APAP oral dose on methemoglobin (MetHb, non-oxygen carrying form) levels and other blood parameters were examined in brown treesnakes. Co-oximetry was used to measure MetHb (%) and other hemoglobin species. Assessment of red blood cell integrity, white blood cell differential counts, and plasma biochemical analyses were conducted to evaluate tissue damage, stress, and liver function. Changes in oxygen carrying capacity were noted in APAP-treated snakes indicated by a 50-60% increase in methemoglobin levels and a 40% decrease in oxyhemoglobin (oxygen-carrying form) levels compared to controls. APAP-treated snakes had decreased lymphocyte and increased monocyte counts while also having increased levels of blood analytes associate with impaired liver function and muscle damage. The proximate cause of death in APAP-treated snakes was likely acute methemoglobinemia and respiratory failure due to severe hypoxia with no observed signs of distress or pain. An orally-ingested lethal dose of APAP appears to be a humane method for lethal control of this species.

Anthropogenic and temporal components in a complex trigger of type 1 diabetes suggest the active participation of antipyretics

Tremendous efforts in research without a conclusion on the cause of type 1 diabetes allow the presumption that there is still a blind spot in the development of T1D that is not covered by current hypotheses. The review of geographical knowledge suggests that there is a well-expressed anthropogenic element within the complex environmental trigger of T1D. On the other hand, the initiation of T1D's directed autoimmunity is temporally related to the organism's immune response, induced by entero-viruses, most expectedly. Consequently, the searched for anthropogenic environmental factor is a player temporally linked to enteroviral infections. This paper discusses the participation of antipyretic medicines, and especially paracetamol, with a whole century's history of growing sales and popularity, including indirect influence through phenacetin during the first half of the 20th century. As proposed by several independent studies, the use of pharmaceuticals to reduce fever may counteract with the protective features of the immune system and create favourable conditions for a virus to spread within the organism and damage specific tissue. A preliminary comparison of paracetamol sales with the incidence of T1D data in Lithuania and the other countries in the North-eastern Baltic region supports this hypothesis.

[Drug-induced hyperglycemia: a study in the French pharmacovigilance database]

OBJECTIVE

To analyse drugs inducing hyperglycemia by using data reported to the French spontaneous reporting system and recorded in the French PharmacoVigilance Database (FPVD).

METHODS

All cases with a report of hyperglycemia and/or diabetes in the French database between 1985 and 2008 were included in the study. We estimated the risk of hyperglycemia linked to drugs by the case/non-case method. Cases were reports including hyperglycemia and non cases all other reports. This risk was estimated through calculation of reporting odds ratios (ROR).

RESULTS

During this period, 1219 reports including the words "hyperglycemia and/or diabetes" were registered (0.34% of the database). This adverse drug reaction occurred 1 fold over 4 in diabetics or as a part of HIV infection. Effect was "serious" in approximatively 50% of cases. We found an increase of risk during exposition with methylprednisolone [ROR=43.5; 95% CI (37.3-50.8)], tacrolimus [ROR=25; 95% CI (17.9-34.8)], olanzapine [ROR=19.9; 95% CI (14.9-26.5)], prednisone [ROR=18.9; 95% CI (15.7-22.8)] or pentamidine [ROR=15.4; 95% CI (8.2-28.3)].

CONCLUSION

Drug classes most frequently found in FPVD linked to hyperglycemia are antiretroviral, steroidal anti-inflammatory, second generation neuroleptic, immunosuppressive and diuretic drugs.