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Reported March 31, 2003

Liver Injury from Diabetic Medications

OAKLAND, Calif. (Ivanhoe Newswire) -- A new study links the use of diabetic medications with an increased risk of acute liver injury or failure.

Medical literature regularly reports on cases of drug-induced liver injury. Doctors are asked to report any suspected cases to manufacturers or regulatory authorities to assist in the evaluation of medication safety after FDA approval. One diabetes medication, troglitazone, was withdrawn from the market in both the United States and the United Kingdom after case reports suggested it causes liver damage. Since diabetes itself can cause liver problems, larger studies are needed to accurately assess the risk of medications used to treat the disease.

In this study, researchers reviewed medical records from about 171,000 patients age 19 and older when they first received oral hypoglycemic drugs or insulin to control their diabetes. The analysis identified 26 cases of acute liver failure and 9 cases of acute liver injury that could not be clearly attributed to a known cause other than use of the diabetes medications. Twenty-seven additional cases, however, had a possible alternative cause, including exposure to hepatotoxic drugs. Just one of the cases had no apparent cause other than the use of the hypoglycemic agent, and that patient was on tolazamide. Eight of the patients died during hospitalization.

The incidence of toxic events was similar for the various medications in the study, and individuals with other chronic diseases besides diabetes were at higher risk of developing complications. The authors write, "Acute liver failure or injury not clearly attributable to other known causes occurred on the order of 1 per 10,000 person-years among diabetic patients treated with oral hypoglycemic drugs or insulin."

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