Medication-induced hyperglycemia: pediatric perspective
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The objective of this review is to identify and describe the drugs that can cause hyperglycemia, with an emphasis on the pediatric population.

Because of acute and long-term complications of hyperglycemia, it is critically important for doctors to recognize medications’ role in causing hyperglycemia, be familiar with the mechanism of actions, and develop strategies to minimize its frequency and related complications.

Euglycemia is a tightly controlled state regulated by the interplay of multiple hormones that balance glucose production and clearance. Among the hormones, insulin has the strongest effect on glucose metabolism. Several medications impair the production, secretion, or action of insulin and thus may lead to drug-induced hyperglycemia. Although the incidence of drug-induced hyperglycemia in children is unknown, with the advent of new medications that are known to cause hyperglycemia, it is expected to be on the rise. Drug-induced hyperglycemia increases the burden of care of patients and is associated with less favorable outcomes such as cardiovascular disease, diabetic emergencies and premature death.

Although many pharmacotherapies that have been associated with hyperglycemia in adults are also used in children, pediatric-specific data on medication-induced hyperglycemia are scarce. The mechanisms of hyperglycemia may involve β cell destruction, decreased insulin secretion and/or sensitivity, and excessive glucose influx. While some medications (eg, glucocorticoids, L-asparaginase, tacrolimus) are markedly associated with high risk of hyperglycemia, the association is less clear in others (eg, clonidine, hormonal contraceptives, amiodarone). In addition to the drug and its dose, patient characteristics, such as obesity or family history of diabetes, affect a child’s risk of developing hyperglycemia. Identification of pediatric patients with increased risk of developing hyperglycemia, creating strategies for risk reduction, and treating hyperglycemia in a timely manner may improve patient outcomes.