5 Obat dan 3

Penyakit sebagai
Penyebab
Diabetes
Jimmy Chan Wei Kit
260110132003
Pavin Subramaniam
260110132009
Najeeha Hadi
260110132020

Corticosteroids
Corticosteroids blunt the action of insulin and promote
hepatic gluconeogenesis, possibly by activation of liver x
receptor- involving phosphoenolpyruvate
carbosykinase gene transcription. From a clinical
standpoint, corticosteroids primarily increase
postprandial blood glucose levels, whereas fasting levels
are unaffected or only mildly elevated.
Eg. Prednisolone, Dexametasone

Thiazide
Antihypertensive
Drugs
The exact mechanism of how thiazide diuretics cause
the development of hyperglycemia is unknown.
However, it is postulated to involve worsening of insulin
resistance, inhibition of glucose uptake, and decreased
insulin release, among other pathways. In addition,
thiazide diuretics are postulated to down-regulate
peroxisome proliferator-activated receptor gamma,
thereby decreasing insulin release in addition to
activating the reninangiotensin-aldosterone system, thus
resulting in elevated levels of aldosterone and resulting
hyperglycemia.
Eg. Hydrochlorothiazide

-blockers
-blockers are thought to contribute to the development
of hyperglycemia by impairing the release of insulin from
the pancreatic -cell. Interestingly, carvedilol and
nebivolol are not associated with the development of
hyperglycemia or new-onset diabetes.
Eg. Propanolol, Atenolol and Metoprolol

Calcineurin Inhibitors
(CNIs)
The postulated mechanism of hyperglycemia results
from inhibition of pancreatic islet -cell expansion
promoted by calcineurin.
Eg. Cyclosporineandtacrolimus.

Protease Inhibitors
Protease inhibitor drugs are thought to create a
homeostatic stress response that decreases insulin
sensitivity, thereby promoting insulin resistance
associated hyperglycemia. Ritonavir has been shown to
directly inhibit glucose transporter type 4 activity in vivo,
accounting for its ability to cause hyperglycemia.
Eg. Ritonavir, Indinavir, Saquinavir

Daftar Pustaka
Corticosteroids
Patel R, Patel M, Tsai R, Lin V, Bookout AL, Zhang Y, Magomedova L,
Li T, Chan JF, Budd
C, Mangelsdorf DJ, Cummins CL: LXR is
required for glucocorticoidinduced hyperglycemia and
hepatosteatosis in mice. J Clin Invest 121:431441, 2011
Friedman JE, Sun Y, Ishizuka T, Farrell CJ, McCormack SE, Herron LM,
Hakimi P,Lechner
P, Yun JS: Phosphoenolpyruvate carboxykinase
(GTP) gene transcription and hyperglycemia are regulated by
glucocorticoids in genetically obese db/db
transgenic mice. J Biol
Chem 272:3147531481, 1997
Clore JN, Thurby-Hay L: Glucocorticoid-induced hyperglycemia.
Endocr Pract 6:469 474, 2009
Thiazide Antihipertensive Drugs
Carter BL, Einhorn PT, Brands M: Thiazide-induced dysglycemia: call
for research from a working group from the National Heart, Lung, and
Blood Institute. Hypertension 52:3036, 2008
Tham DM, Martin0McNully B, Wang YX: Angtiotensin II is associated
with activation of NF-kB-mediated genes and downregulation of
PPARS. Physiol Genomics 11:21
30, 2002

Daftar Pustaka
Beta Blockers
Wicklmayr M, Rett K, Deitze G: Effects of beta blocking agents on insulin
secretion and
glucose disposal. Horm Metab Res 22 (Suppl. 22):29
33,1990
Torp-Pedersen C, Metra M, Charlesworth A, Spark P, Lukas MA, Poole-Wilson
PA, Swedberg K, Cleland JGF, Di Lenarda A, Remme WJ, Scherhag A:
Effects of metoprolol and carvedilol
on pre-existing and new onset of
diabetes in patients with chronic heart failure: data from the Carvedilol
Or Metoprolol Eurpoean Trial (COMET). Heart 93:968973, 2007
Rosei EA, Rizzoni D: Metabolic profile of nebivolol, a beta-adrenoreceptor
antagonist with unique charachteristics. Drugs 67:10971107, 2007
De Boer RA, Doehner W, van der Horst ICC, Anker SD, Babalis D, Roughton
M, Coats
AJ, Flather MD, van Veldhuisen DJ: Influence of diabetes
mellitus and hyperglycemia on prognosis in patients 70 years old with
heart failure and effects of nebivolol (data from the study of effects of
nebivolol intervention on outcomes and rehospitalization and
rehospitalization in seniors with heart failure [SENIORS]). Am J Cardiol
106:7886, 2010
Calcineurin Inhibitors (CNIs)
Bernal-Mizrachi E, Cras-Mneur C, Ye BR, Johnson JD, Permutt MA:

Daftar Pustaka
Protease Inhibitors
Mulligan K, Grunfield C, Tai VW, Algren H, Pang M, Chernoff DN, Lo JC,
Schambelan M: Hyperlipidemia and insulin resistance are induced
by protease inhibitors independent of changes in body composition
in patients with HIV infection. J Acquir Immune Defic Syndr Hum
Retrovirol 23:3543, 2000
Vyas AK, Koster JC, Tzekov A, Hruz PW: Effects of the HIV protease
inhibitor ritonavir on GLUT4 knock-out mice. J Biol Chem 285:36395
36400, 2010