Clinical review: Drug-induced hypoglycemia: a systematic review.
BACKGROUND
Drug-induced hypoglycemia is a significant adverse effect that may cause important morbidity.


OBJECTIVE
The aim of the study was to systematically review the literature for drugs reported to cause hypoglycemia and assess the quality of evidence and strength of association supporting this causal link.


METHODS
We searched electronic databases (MEDLINE, EMBASE, Web of Science, and SCOPUS) and the drug information system Micromedex through November 2007 and sought additional references from experts.


METHODS
Studies were eligible if they reported hypoglycemia as a side effect of a drug not used to treat hyperglycemia, regardless of their design, language, size, or follow-up duration. We excluded hypoglycemia caused by industrial exposures, nonpharmacological chemical exposures, alcohol, herbs, nutritional supplements, and in vitro and animal studies.


METHODS
Reviewers extracted study characteristics and methodological quality and, when possible, data to estimate the odds of developing hypoglycemia when exposed to the offending agent.


RESULTS
We found 448 eligible studies that described 2696 cases of hypoglycemia associated with 164 different drugs. The quality of evidence supporting associations between drugs and hypoglycemia was mostly very low due to methodological limitations and imprecision. The most commonly reported offending drugs were quinolones, pentamidine, quinine, beta blockers, angiotensin-converting enzyme agents, and IGF.


CONCLUSIONS
Very low quality evidence substantiates the association between hypoglycemia and the use of numerous nondiabetic drugs.
Murad
M Hassan
MH
Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Coto-Yglesias
Fernando
F
Wang
Amy T
AT
Sheidaee
Nasim
N
Mullan
Rebecca J
RJ
Elamin
Mohamed B
MB
Erwin
Patricia J
PJ
Montori
Victor M
VM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged