Sertraline-Induced Hypoglycemia in Type 2 Diabetes Patients

ABSTRACT Objective: To report the clinical outcomes of 2 type 2 diabetes patients admitted for severe and precipitous hypoglycemia after initiation of sertraline and subsequent resolution after discontinuation of the medication. Methods: Case reports with literature review. Results: Case 1: A 58-year-old African American man with poorly controlled type 2 diabetes was admitted for unresponsiveness due to severe hypoglycemia. Twelve days prior to admission, he was started on sertraline and observed declining fasting blood sugar levels, with 2 episodes of symptomatic hypoglycemia. Despite discontinuation of insulin for 48 hours during admission, resolution of hypoglycemia only occurred after discontinuation of the sertraline. Despite titration of insulin to pre-admission dosage following discharge, he was re-admitted shortly for hyperosmolar hyperglycemic state. Case 2: An 85-year-old Caucasian man with well-controlled type 2 diabetes was admitted for 3 episodes of hypoglycemia in 1 day. At home, he was on metformin and pioglitazone for his diabetes. He was started on sertraline 2 months prior, with progressively decreasing fasting glucose levels. After discontinuation of the sertraline on the second day of his admission, there were no further recurrences of hypoglycemia. Conclusion: These cases demonstrate through temporal correlation that sertraline may be associated with hypoglycemia in conjunction with antidiabetic agents. Although this potential side effect is rarely reported and not mechanistically defined, sertraline and other selective serotonin re-uptake inhibitors should be considered as possible etiologies when evaluating severe recurrent hypoglycemia. Abbreviations: eGFR = estimated glomerular filtration rate SSRI = selective serotonin re-uptake inhibitor