Understanding How Diabetes Affects Patient Response To Medications

Robert G. Smith DPM, MSc, RPh, CPed

   In addition, the plasma protein binding of drugs may be significantly reduced. This could subsequently influence the pharmacokinetic processes of distribution and elimination. Researchers have shown that the activity of several drug metabolizing enzymes and drug transporters is impaired in chronic renal failure. Diabetic renal dysfunction affects more than just the renal handling of drugs and/or active drug metabolites.18 Even when patients with diabetes and renal dysfunction carefully follow recommended dosage adjustments, adverse drug reactions remain common.

Other Considerations With Diabetes And Pharmacodynamics

Data regarding the effects of diabetes on pharmacodynamics is very limited.5,6 As I noted earlier, there is evidence that the effects of diabetes are not limited to drug absorption and disposition, but can alter drug response as well.5,6 Previously published studies have reported the effects of diabetes on the pharmacodynamics of cardiovascular drugs such as lipid lowering agents and antihypertension drugs.5,6

   Clinical observations suggest that drug response to other therapeutic classes of drugs may also be altered in patients with diabetes.5 Available data indicates that there is a significant variability in drug response in patients with diabetes. An understanding of diabetes-mediated changes in pharmacodynamics as well as the source of the variability in patient response to treatment should lead to better podiatric medical management of patients with diabetes.

In Conclusion

The available data indicates that there is significant variability in drug response in patients with diabetes. Researchers have shown that the pharmacokinetics and pharmacodynamics of a number of drugs are significantly altered by diabetes mellitus.

   In regard to therapeutic medication regimens established for non-diabetic patients, applying these regimens in patients with diabetes may result in an increased incidence of therapeutic failures or undesirable adverse effects.

   Dr. Smith is in private practice in Ormond Beach, Fla.

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