Evidence map›Paper›PMID 18981326›Full record

Trial reportHypertension (Dallas, Tex. : 1979)2008

Changes in serum potassium mediate thiazide-induced diabetes.

Tariq Shafi, Lawrence J Appel, Edgar R Miller, Michael J Klag, Rulan S Parekh

Erratum issuedOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Hypertension (Dallas, Tex. : 1979), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 53 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 3 pooled it
7.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 3 syntheses or guidelines pooled it, 155 citations in OpenAlex.

  1. Pooled it
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  7. Incidence of hyperglycemia and diabetes and association with electrolyte abnormalities in pediatric solid organ transplant recipients.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2017
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  14. Medication-Induced Hyperglycemia and Diabetes Mellitus: A Review of Current Literature and Practical Management Strategies.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Tariq ShafiDivision of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21224-2780, USA. tshafi@jhmi.edu
Lawrence J Appel
Edgar R Miller
Michael J Klag
Rulan S Parekh
Johns Hopkins University · US

Funding

RENAL DISEASE EPIDEMIOLOGY TRAINING GRANTT32DK007732 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI CREWS, DEIDRA CANDICE · 1995 to 2024
$7.7M
Longitudinal Study of DialysisR01DK072367 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI PAREKH, RULAN S · 2007 to 2011
$3.7M
MALD FIND RenewalU01DK057304 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI PAREKH, RULAN S · 1999 to 2007
$2.5M
NIDDK NIH HHS 5T32DK007732-12NIDDK NIH HHS R01 DK072367NIDDK NIH HHS T32 DK007732NIDDK NIH HHS U01 DK057304
6 · The paper itself

Abstract

Thiazides, recommended as first-line antihypertensive therapy, are associated with an increased risk of diabetes. Thiazides also lower serum potassium. To determine whether thiazide-induced diabetes is mediated by changes in potassium, we analyzed data from 3790 nondiabetic participants in the Systolic Hypertension in Elderly Program, a randomized clinical trial of isolated systolic hypertension in individuals aged >or=60 years treated with chlorthalidone or placebo. Incident diabetes was defined by self-report, antidiabetic medication use, fasting glucose >or=126 mg/dL, or random glucose >or=200 mg/dL. The mediating variable was change in serum potassium during year 1. Of the 459 incident cases of diabetes during follow-up, 42% occurred during year 1. In year 1, the unadjusted incidence rates of diabetes per 100 person-years were 6.1 and 3.0 in the chlorthalidone and placebo groups, respectively. In year 1, the adjusted diabetes risk (hazard ratio) with chlorthalidone was 2.07 (95% CI: 1.51 to 2.83; P<0.001). After adjustment for change in serum potassium, the risk was significantly reduced (hazard ratio: 1.54; 95% CI: 1.09 to 2.17; P=0.01); the extent of risk attenuation (41%; 95% CI: 34% to 49%) was consistent with a mediating effect. Each 0.5-mEq/L decrease in serum potassium was independently associated with a 45% higher adjusted diabetes risk (95% CI: 24% to 70%; P<0.001). After year 1, chlorthalidone use was not associated with increased diabetes risk. In conclusion, thiazide-induced diabetes occurs early after initiating treatment and appears to be mediated by changes in serum potassium. Potassium supplementation might prevent thiazide-induced diabetes. This hypothesis can and should be tested in a randomized trial.

Indexed as

AgedAntihypertensive AgentsAtenololBlood PressureChlorthalidoneDiabetes Mellitus, Type 2Drug Therapy, CombinationFemaleHumansHypertensionHypokalemiaIncidenceMaleMiddle AgedPotassiumProportional Hazards ModelsAntihypertensive AgentsAtenololChlorthalidonePotassiumReserpine

Identifiers

PMID18981326
PMCPMC2676425
OpenAlexW2157983429

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.