On July 31st, Patrick Bills filed a lawsuit against Bristol-Myers Squibb claiming that its drug, Tequin, the brand name of gatafloxacin, caused his diabetes. The New England Journal of Medicine reported on March 30, 2006 that gatifloxacin causes both hypo- and hyperglycemia, the precursor of diabetes. Is this drug unique, or is it possible that many drugs increase the chance of this debilitating and fatal disease?

The number of people becoming diabetic is increasing dramatically. According to Express Scripts, in the U.S. it doubled in 5-19 year olds between 2002 and 2005. In a study for the Financial Times, Medco found that type 2 diabetes more than doubled in children between 2001 and 2005. The most common explanation for this very troubling increase is that it's dietary, the result of eating too much and eating unhealthy food. Is this, though, the only reason?

Atypical antipsychotics, modern drugs used to control symptoms of schizophrenia, are known to cause diabetes—but is it possible that other drugs do, too? Could it be that unnecessary prescribing is a factor in the explosive increase in diabetes?

Jeni Dingman, founder of PULSE America (Persons United Limiting Substandards and Errors in Healthcare), responds, “There has been an alarming increase in children taking medications. It makes someone wonder if there's a link.”

Diabetes-pharmaceuticals link?

Recent research in England appears to document that unnecessary prescribing is a factor in the diabetes epidemic. Dr. Lisa Landymore-Lim, a chemist specializing in immunology and biomedical chemistry, has documented a curious link between excessive drug prescriptions and the incidence of diabetes.

She has studied chemicals and drugs known to induce diabetes, including the antibiotic streptozocin, the chemical alloxan, and the rat poison, vacor. All of these have a chemical characteristic that allows them to bond tightly to zinc, an ingredient in insulin. When this bonding makes zinc unavailable, insulin cannot form. A lack of insulin is virtually the definition of diabetes. According to Dr. Landymore-Lin, there are many drugs in common use that have the same diabetes-inducing chemical characteristic.

The National Health Service in the UK tracks the rate of diabetes in children under age 15 according to the areas in which they live. Dr. Landymore-Lim noted that the numbers in rural areas are significantly higher than urban areas. Writing in the December 2006 issue of WDDTY (What Doctors Don't Tell You), she noted that doctors serving rural areas can dispense, and profit from, pharmaceuticals, whereas those serving urban areas are prohibited from doing so. It's assumed to be more difficult for people who live far from a pharmacy to have prescriptions filled.

In rural areas, GPs are free to profit from dispensing drugs, while urban GPs may not do so. Dr. Landymore-Lim writes, “It was also noticeable that in some of these practices, antibiotics were apparently being liberally prescribed to babies and children.” She found that rural, drug-dispensing GP practices tend to be significantly more affluent than their urban counterparts. The financial incentive from prescription sales appears to result in rural areas having significantly greater pharmaceutical drug intake than urban areas.

The East Anglia region of England, which is mostly rural, has a rate of 17.7 diabetes cases per 100,000 children under age 15. In Urban North West Thames, consisting of a portion of densely-populated London, the same age group's diabetes rate is 8.0, less than half East Anglia's. How much of this is the result of excess prescribing by doctors is not definitive. However, as Dr. Landymore-Lim wrote, “Since dispensing doctors are more liberal in handling out drugs, then it might be expected that an area with a high proportion of dispensing doctors would also have a high incidence of disease—which is indeed the case here. Furthermore, regions with a higher number of prescriptions per person also had a higher incidence of diabetes.”

Issues raised

The research by Dr. Landymore-Lim brings the concern of a likely connection between the increase of diabetes and the use of prescription drugs in general. At issue, too, is the implication that physicians prescribe more pharmaceuticals when there is a profit motive.

Which drugs are implicated?

These commonly prescribed drugs have the chemical characteristic that may cause diabetes:

* Antibiotics: penicillins, cephalosporins, erythomycin

* Tranquilizers: barbiturates, benzodiazepines (such as Valium)

* Others: syntocinon (labor inducer), ergometrine (stops postpartum bleeding), acetaminophen (Tylenol)

Dr. Landymore-Lim says that she is unaware of any studies to determine whether these drugs can be definitively implicated for inducing diabetes. Her research documents how such drugs may induce diabetes and that areas in which they are prescribed more have a higher incidence of diabetes Ultimately, though, it will require funding and the cooperation of the medical profession to provide the research needed to definitively document whether these common drugs cause diabetes.

Her focus was primarily on the drug-diabetes connection, but it also demonstrates a significant factor in how pharmaceuticals are prescribed. The opportunity of an increased income appears to strongly influence physicians in their decisions about whether to prescribe drugs.

The iatrogenic connection

The diabetes epidemic may be partially caused by the medical profession's overuse of drugs. How can parents protect their children against unnecessary or dangerous prescriptions? Jeni Dingman suggests, “My advice is that everyone should be very informed as a patient. You should never take anything you're told by your medical professional at face value when it concerns medication. Always learn for yourself by using the internet and going to the website of the companies that make the medications and learn all about side effects, interactions, and other potential problems with medications.”

How many more Patrick Bills are out there? How many children are developing diabetes because their doctors have prescribed unnecessary drugs? The answers to these questions may never be known, since there are many causative factors in diabetes. However, before giving your child that antibiotic prescription, taking a tranquilizer, having labor induced for your doctor's or your own convenience, or popping an acetaminophen for every ache, it might be worth considering a potential for increasing the risk of diabetes.

As Jeni Dingman said, “Ask your physician if he or she is getting any financial incentive from the pharmaceutical company that makes the drug that's just been prescribed. Your provider will be happy that you feel comfortable discussing such things. It will create a closer relationship and future interactions may be enriched.”