{"id":1144,"date":"2012-10-01T00:00:36","date_gmt":"2012-10-01T05:00:36","guid":{"rendered":"http:\/\/rhochistj.org\/RhoChiPost\/?p=1144"},"modified":"2014-02-24T16:21:40","modified_gmt":"2014-02-24T21:21:40","slug":"duloxetines-effect-blood-glucose-levels","status":"publish","type":"post","link":"https:\/\/rhochistj.org\/RhoChiPost\/duloxetines-effect-blood-glucose-levels\/","title":{"rendered":"Duloxetine\u2019s Effect on Blood Glucose Levels"},"content":{"rendered":"

By: Neal Shah, Co-Editor-in-Chief<\/p>\n

–<\/p>\n

Duloxetine is a serotonin (5HT) and norepinephrine (NE) reuptake inhibitor (SNRI) introduced to the US market in 2004, indicated for the treatment of diabetic neuropathic pain.<\/span>1<\/sup> A chemical figure of duloxetine is shown [in the PDF].<\/span>2<\/sup><\/p>\n

It was developed in an effort to mimic tricyclic antidepressant mitigation of neuropathic pain without the extensive systemic side effects that limit their use.1<\/sup> Though duloxetine has not been shown to have any true neuroprotective effects, its combined SNRI effects contribute to pain cessation along the pain tracts in the central nervous system.1<\/sup> An interesting finding during trials was that duloxetine apparently slightly worsened both glucose control and raised hemoglobin A1c (HbA1c<\/sub>), a marker of average blood glucose over a three-month period.1 <\/sup>The package insert reports an average glucose increase of 12 mg\/dL and an increase of HbA1c by 0.5% compared to placebo in a 41 week study.3<\/sup> A division of Novartis found in a meta-analysis of seven trials that while impairment of glucose control was significant, at the end of a 52 week trial, changes in plasma glucose and A1c were statistically insignificant.4<\/sup> Another meta-analysis done by Abbott laboratories found that these changes indicated no enhanced disease progression.5 <\/sup><\/p>\n

In conclusion, when counseling a diabetic patient about the effects of duloxetine, inform them that they may see a slight increase in their blood glucose and\/or A1c, and that the benefits of possible neuropathic pain relief may outweigh this slight increase.<\/p>\n

SOURCES:<\/strong><\/span><\/p>\n

    \n
  1. Smith T and Nicholson R. Review of duloxetine in the management of diabetic peripheral neuropathic pain. Vasc Health Risk Manag. 2007 December; 3(6): 833\u201444.<\/li>\n
  2. Duloxetine – Compound Summary. Available at: http:\/\/pubchem.ncbi.nlm.nih.gov\/sumary\/summary.cgi?cid=60835<\/a>. Accessed 15 September 2012.<\/li>\n
  3. Eli Lilly and Company. Cymbalta (duloxetine) package insert. Accessed 8 September 2012.<\/li>\n
  4. Crucitti A, Zhang Q, Nilsson M et al. Duloxetine treatment and glycemic controls in patients with diagnoses other than diabetic peripheral neuropathic pain: a meta-analysis. Curr Med Res Opin. 2010 Nov;26(11):2579\u201488. Epub 2010 Sep 27.<\/li>\n
  5. Hall JA, Wang F, Oakes TM et al. Safety and tolerability of duloxetine in the acute management of diabetic peripheral neuropathic pain: analysis of pooled data from three placebo-controlled clinical trials. Expert Opin Drug Saf. 2010 Jul;9(4):525\u201437.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    By: Neal Shah, Co-Editor-in-Chief – Duloxetine is a serotonin (5HT) and norepinephrine (NE) reuptake inhibitor (SNRI) introduced to the US market in 2004, indicated for the treatment of diabetic neuropathic pain.1 A chemical figure of duloxetine is shown [in the PDF].2 It was developed in an effort to mimic tricyclic antidepressant mitigation of neuropathic pain…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,4],"tags":[343,22,1823,1160,784,102,15,13,785,2227,29,314,20,1142,601,725,363,1625,47,19,671,220,36,99,187,21,453,1003,16,17,1061],"class_list":["post-1144","post","type-post","status-publish","format-standard","hentry","category-clinical","category-featured","tag-and","tag-blood","tag-chemical","tag-control","tag-cymbalta","tag-december","tag-disease","tag-drug","tag-duloxetine","tag-ebola-virus-disease","tag-editor","tag-for","tag-health","tag-inform","tag-inhibitor","tag-mg","tag-of","tag-or","tag-pain","tag-patient","tag-r","tag-review","tag-risk","tag-september","tag-side","tag-study","tag-system","tag-tm","tag-treatment","tag-trial","tag-with"],"views":12441,"_links":{"self":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/1144","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/comments?post=1144"}],"version-history":[{"count":0,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/1144\/revisions"}],"wp:attachment":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/media?parent=1144"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/categories?post=1144"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/tags?post=1144"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}