Pentamidine-Induced Derangements of Glucose Homeostasis: Determinant Roles of Renal Failure and Drug Accumulation: A Study of 128 Patients
Abstract
Objective To assess the prevalence, presentation, and risk factors of pentamidine-induced dysglycemia. Research design and methods Blood glucose values were screened in 244 consecutive immunocompromised patients with Pneumocystis carinii pneumonia: 116 being treated with cotrimoxazole and 128 others with pentamidine. Results Two cotrimoxazole patients developed diabetes as a result of necrotizing pancreatitis (1.7%); the others remained euglycemic. Forty-eight pentamidine-treated patients (38.5%) developed severe glucose homeostasis disorders: hypoglycemia in 7, hypoglycemia and then diabetes in 18, and diabetes alone in 23 (P Conclusions Pentamidine-induced dysglycemic accidents are primarily due to inappropriate insulin release and toxicity to the islet B-cells. Drug accumulation due to excessive doses, iterative courses, and/or renal impairment is the determining risk factor.
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Pentamidine causes hypoglycemia via β-cell toxicity and death, leading to release of preformed insulin.
“β -cell toxicity and death, leading to release of preformed insulin [109]”
From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [109]
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Marks, V., & Teale, J. D. (1999) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70088-8 · Cited by 150 · see citing works
Drug-induced endocrine disorders in the intensive care unit
Thomas, Z., Bandali, F., McCowen, K., & Malhotra, A. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181dda0f2 · Cited by 30 · see citing works
Non-Diabetic Hypoglycemia: Evaluation and Management in Adults
Looi, E., & Lawler, H. M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14134393 · Cited by 10 · see citing works
“…Anti-protozoal used for Pneumocystis jiroveci prophylaxis and treatment [108] β -cell toxicity and death, leading to release of preformed insulin [109] Hypoglycemia tends to occur within the first few days of administration followed by hyperglycemia in the subsequent 1–3 months [109] Quinine…”
- Authors
- Assan, R., Perronne, C., Assan, D., Chotard, L., Mayaud, C., Matheron, S., & Zucman, D.
- Affiliations
- Hôpital Bichat-Claude-Bernard (FR)
- Service des Maladies Infectieuses, Hôpital Claude Bernard Paris, France
- Hôpital Tenon (FR)
- Bicêtre Hospital (FR)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1995-01-01
- Volume
- 18
- Issue
- 1
- Pages
- 47-55
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W1980408462
- Cited by
- 88
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 6 · 2014: 1 · 2012: 3
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Pneumocystis jirovecii pneumonia detection and treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- pentamidine, drug-induced hypoglycemia, drug-induced diabetes, glucose homeostasis, Pneumocystis carinii pneumonia, renal dysfunction, drug accumulation, insulin secretion, beta-cell dysfunction, immunocompromised patients, trimethoprim-sulfamethoxazole, anoxia, shock, isethionate
- MeSH terms
- Adult, Diabetes Mellitus, Female, Humans, Hyperglycemia, Hypoglycemia, Infusions, Intravenous, Male, Pentamidine, Pneumonia, Pneumocystis, Radioimmunoassay, Retrospective Studies, Risk Factors, Trimethoprim, Sulfamethoxazole Drug Combination, AIDS-Related Opportunistic Infections
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