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To the Editor: In their Contempo Updates article about drug-induced hyperglycemia,¹ Drs Luna and Feinglos did not mention glucosamine sulfate, a drug that is increasingly used in the treatment of osteoarthritis.²

By increasing glucose flux through the hexosamine biosynthetic pathway, glucosamine has been shown to induce insulin resistance in skeletal muscle.³ Furthermore, acceleration of the hexosamine pathway also inhibits glucose-induced insulin secretion, resulting in hyperglycemia.⁴ In a case report of a patient with disabling hypoglycemic symptoms caused by metastatic insulinoma, the use of glucosamine for osteoarthritis led to marked improvement of these symptoms.⁵ In industrialized countries where people are becoming increasingly overweight and thus at increased risk of osteoarthritis, the diabetogenic effect of glucosamine must be considered.

N. Norman Chan, MRCP; Risa Osaki, MRCP; C. C. Chow, FRCP; Juliana C. N. Chan, MD,FRCP; Clive S. Cockram, MD,FRCP
Department of Medicine and Therapeutics
Prince of Wales Hospital
Hong Kong

1. Luna B, Feinglos MN. Drug-induced hyperglycemia. JAMA. 2001;286:1945-1948. FREE FULL TEXT 2. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised placebo-controlled clinical trial. Lancet. 2001;357:251-256. FULL TEXT | ISI | PUBMED 3. Monauni T, Zenti MG, Cretti A, et al. Effects of glucosamine infusion on insulin secretion and insulin action in humans. Diabetes. 2000;49:926-935. ABSTRACT 4. Giaccari A, Morviducci L, Zorretta D, et al. In vivo effects of glucosamine on insulin secretion and insulin sensitivity in the rat: possible relevance to the maladaptive responses to chronic hyperglycaemia. Diabetologia. 1995;38:518-524. ISI | PUBMED 5. Chan NN, Baldeweg SE, Tan TMM, Hurel SJ. Glucosamine sulphate and osteoarthritis. Lancet. 2001;357:1618-1619.

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