Professor Ruth Andrew PhDChair of Pharmaceutical EndocrinologyUniversity/BHF Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of Edinburgh

Small Increased Risk of Diabetes with Common Drug for Prostate Enlargement Interview with:

Professor Ruth Andrew PhDChair of Pharmaceutical EndocrinologyUniversity/BHF Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of Edinburgh

Dr. Andrew

Professor Ruth Andrew PhD
Chair of Pharmaceutical Endocrinology
University/BHF Centre for Cardiovascular Science
Queen’s Medical Research Institute
University of Edinburgh What is the background for this study? What are the main findings?

Response: Our research group has been interested for a number of years in how stress hormones (called glucocorticoids) influence the risk of heart disease and diabetes. Glucocorticoids help us control stress and regulate how the body handles its fuel, for example the carbohydrate and fat we eat. However exposure to high levels of glucocorticoids, can increase the risk of diabetes, obesity and high blood pressure.

We studied men with prostate disease who took 5α-reductase inhibitors, because over and above the beneficial actions of these drugs in the prostate, they also slow down inactivation of glucocorticoids. We had carried out some short term studies with the drugs in humans and found that they reduced the ability of insulin to regulate blood glucose. Therefore in the study we have just published in the BMJ, we examined how patients receiving these drugs long-term responded and particularly we were able to show that over an 11 year period that there was a small additional risk of developing type 2 diabetes, the type of disease common in older people, compared with other types of treatments. What should readers take away from your report?

Response: Firstly the risk is modest, so not everyone who we studied developed diabetes. We estimate that an extra 16 new cases of diabetes arose for every 1000 patients taking the drugs over a 10 year period. Many factors about lifestyle and health can add together to increase diabetes risk so for individual patients it is important to recognise these factors to understand the global burden for that individual patient. Therefore we would recommend patients starting these drugs, particularly if they have other risk factors, to have more frequent monitoring of their blood glucose, in order that any changes can be spotted at an early stage and before some of the complications of diabetes that are hard to reverse start to arise. The drugs are extremely effective for prostate disease so we would not recommend anyone stopping them. What recommendations do you have for future research as a result of this work?

Response: Looking forward it would be good to identify if there are sub-group of patients who are at greater risk of developing diabetes and can be identified in advance, so will be looking to try to better understand susceptibility. We will also study with people with pre-existing diabetes, when they start the drugs, and evaluate how their disease progresses e.g. do they need injectable insulin sooner? Is there anything else you would like to add?

Response: Our work came about through an excellent collaboration between myself in the University of Edinburgh and Dr Li Wei at UCL and with valuable input from colleagues at Dundee, Newcastle and Taiwan. We were funded by the Edinburgh and Lothians Health Foundation and the. 


Incidence of type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors: population based cohort study

BMJ 2019; 365 doi: (Published 10 April 2019)Cite this as: BMJ 2019;365:l1204


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Last Updated on April 24, 2019 by Marie Benz MD FAAD