ERYTHROPOIETIN CAN DETERIORATE GLUCOSE CONTROL IN UREMIC NON-INSULIN-DEPENDENT DIABETIC-PATIENTS

Two patients with non-insulin-dependent diabetes mellitus(NIDDM) and m oderate chronic renal failure experienced a worsening of glycaemic con trol when recombinant human erythropoietin (r-HuEPO) was introduced, l eading to insulin therapy. A 71-year-old woman with a 20-year history of NIDDM had presented histologically documented diabetic nephropathy for 2 years during which glucose control was stabilized by a diet and glibenclamide 10 mg. In the 6 months following introduction of r-HuEPO , hyperglycaemic symptoms developed, and HbA1C increased from 8.9 % to 12.3 %. During this period, no intercurrent events occurred, except e pistaxis due to accelerated hypertension one month after r-HuEPO was s tarted. A 62-year-old man had a 15-year history of NIDDM, with prolife rative retinopathy, macroproteinuria and chronic renal failure for 4 y ears. The day after the first injection of r-HuEPO, capillary glucose level rose dramatically. In both of these cases, antihypertensive trea tment was increased and insulin introduced. The role of r-HuEPO in hyp erglycaemia was probable in the first case and highly probable in the second. Reports about the effects of r-HuEPO on glucose metabolism in uraemic patients are conflicting. Short-and long-term effects can diff er although long-term benefit is likely. The fact that our patients we re not dialized may have been important Clinicians should be aware tha t glucose control may deteriorate with r-HuEPO, requiring some uraemic NIDDM patients to undergo insulin therapy.