How Effective is Hydroxychloroquine for Diabetes?
Executive Summary
- Hydroxychloroquine is effective against something very surprising — which is diabetes.
Introduction
One area for which Hydroxychloroquine is useful, but it is very little known, is treating diabetes.
HCQ and Diabetes Reduction
These quotes are from the article Hydroxychloroquine Use Is Associated With Decreased Incident Cardiovascular Events in Rheumatoid Arthritis Patients.
Hydroxychloroquine has been used in the treatment of RA for decades and is associated with decreased risk of diabetes, a less atherogenic lipid profile, and antithrombotic properties due to effects on platelet aggregation.
The biological plausibility of this protective association is supported by the favorable associations of hydroxychloroquine with glucose and lipids in RA patients and with thrombosis in lupus patients and nonrheumatic patients.
Wasko et al reported a decreased risk of incident diabetes in hydroxychloroquine users compared with nonusers in RA, and this reduction increased with prolonged use, suggesting a causative effect. This observation was validated in subsequent studies. Hydroxychloroquine use was also associated with decreased hemoglobin A1c in 45 diabetic patients with rheumatologic diseases and with improved insulin sensitivity in nondiabetic obese patients with systemic inflammatory conditions.
Meta-Analysis of HCQ and Diabetes
The meta-analysis study titled Potential Effect of Hydroxychloroquine in The Potential Effect of Hydroxychloroqine for Diabetes Mellitus: A Systematic Review on Preclinical and Clinical Trial Studies reviewed the scientific literature using the following techniques.
Electronic databases including PubMed and Scopus as well as clinicaltrials.gov have been searched using different searching terms: “hydroxychloroquine,” “diabetes mellitus,” “hyperglycemia,” and “insulin resistance.”
And it found the following.
Type II diabetic patients might require insulin in addition to oral hypoglycemic agents, which is consistently augmented the side effects.
Another experimental study suggested that compared to monotherapy, a combination of HCQ with oral antihyperglycemic drugs (metformin and glibenclamide) significantly decreased blood glucose level and improved lipid profiles.
Hyperglycemia, which was uncontrolled with a combination of the optimum dose of metformin and glimepiride, experienced better glycemic benefit treated with 400 mg of HCQ for 24 weeks.
Prediabetes is considered as an intermediate clinical condition without complete definitive criteria of diabetes, but with blood glucose higher than the normal range. Patients with a prediabetes state are at increased risk for clinical DM and are also predisposed to various complications including cardiovascular disorders.
In an RCT-based study, 39 prediabetic patients who received 6.5 mg/kg/day HCQ for 12 weeks showed a significant increment of insulin level and reduction of blood glucose level, and the hypoglycemic effect of HCQ also did not affect body organs and metabolic components.
HCQ is the safest DMARD, but gastrointestinal discomfort and pruritus have been among the commonly reported side effects. Because of the promising antidiabetic efficacy, relative safety, and low cost of HCQ, it can emerge as a valuable therapeutic option in the management of type II DM patients uncontrolled by conventional oral therapies.
It has been shown that during inflammation, cytokines such as tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) increased adiposity and insulin resistance by triggering key steps in the insulin signaling, hence influencing insulin and glucose metabolism.
Improvement in Glycemic Control
The following quotes are from the article A favorable effect of Hydroxychloroquine on glucose and lipid metabolism beyond its anti-inflammatory role.
Patients with sulfonylurea-refractory type 2 diabetes mellitus (T2DM), treated with HCQ, demonstrated an improvement in their glycemic control