title: Development of low blood glucose readings in nine non-diabetic patients treated with tumor necrosis factor-alpha inhibitors: a case series.
abstract: BACKGROUND
  Treatment with various biological agents in disease states such as rheumatoid arthritis has been associated with multiple side effects. Whereas many of these are frequently reported in the literature, hypoglycemia, a possible side effect of tumor necrosis factor-alpha inhibitors, may be underpublicized.
  
  
  METHODS
  We report nine cases of non-diabetic Caucasian women who were between 29 and 68 years of age and who developed low glucose readings after treatment with tumor necrosis factor-alpha inhibitors. We provide a more detailed discussion of existing evidence of the role of tumor necrosis factor-alpha in the pathogenesis of inflammation and its impact on glycemic equilibrium.
  
  
  CONCLUSIONS
  Physicians using tumor necrosis factor-alpha inhibitors in the treatment of various rheumatic and other autoimmune diseases should be aware of the potential for the development of glycemic disturbance in these patients. A further role of tumor necrosis factor-alpha inhibitors in the glycemic equilibrium warrants larger controlled trials in patients with and those without a history of diabetes.
authors.affiliation: Department of Rheumatology, Largo Medical Center, Nova Southeastern University College of Osteopathic Medicine, 2025 Indian Rocks Road S, Largo, FL 33774, USA. jadwiga.czajkowska@mwumail.midwestern.edu.
authors.forename: Jadwiga B
authors.initials: JB
authors.lastname: Czajkowska
authors.forename: Brandon
authors.initials: B
authors.lastname: Shutty
authors.forename: Susan
authors.initials: S
authors.lastname: Zito