Thiazide diuretic and Diabetes

Q: 54 year old male is admitted to ICU with Diabetes Ketoacidosis (DKA). Review of his home medications list showed antihypertensives which includes diuretic therapy. Which of the following diuretic (select one) is found to be associated with the Type 2 Diabetes?

A) Thiazide
B) Furosemide
C) Amiloride 
D) Spironolactone
E) Triamterene


Answer: A 

It is said the with each 0.5 mEq/L decrease in serum potassium there is a association of  about a 45 percent higher risk of new diabetes. Thiazide diuretics causes a resultant decrease in insulin secretion. Possible mechanism is a failure of potassium channels to close in response to rising plasma glucose concentrations, causing decrease in insulin secretion. On the positive note, this risk can be mitigated by proper potassium supplement or choosing low dose of thiazide diuretics.


References:

1.  Kostis JB, Wilson AC, Freudenberger RS, et al. Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes. Am J Cardiol 2005; 95:29. 

2. Harper R, Ennis CN, Heaney AP, et al. A comparison of the effects of low- and conventional-dose thiazide diuretic on insulin action in hypertensive patients with NIDDM. Diabetologia 1995; 38:853.

3. Helderman JH, Elahi D, Andersen DK, et al. Prevention of the glucose intolerance of thiazide diuretics by maintenance of body potassium. Diabetes 1983; 32:106. 

4. Shafi T, Appel LJ, Miller ER 3rd, et al. Changes in serum potassium mediate thiazide-induced diabetes. Hypertension 2008; 52:1022. 

5. Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review. Hypertension 2006; 48:219.