One factor in the diabetes epidemic may be prescription drugs and vaccines, some of which have been found to cause diabetes as a side-effect. The chief culprits are:

* Diuretics
These water-retention drugs have been suspected of causing diabetes, but a large-scale study failed to find any connection (N Engl J Med, 2000; 342: 905-12).

* Corticosteroid drugs
Often prescribed for inflammation in arthritis, allergies, skin problems and asthma, a major side-effect of these drugs is to raise blood glucose levels and so cause type 2 diabetes. Generic names include betamethasone, budesonide, cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone and triamcinolone.

* Beta-blockers
These anti-high blood pressure drugs have been shown to increase the risk of diabetes, probably by interfering with the insulin-receptor cells in the pancreas, leading to decreased insulin sensitivity (N Engl J Med, 2000; 342: 905-12). Generic names include atenolol, metoprolol, propanolol and any other drug names ending in ‘olol’.

* Antipsychotic drugs
According to a recent report, 'treatment with antipsychotic medications is associated with impaired glucose metabolism, exacerbation of existing type 1 and 2 diabetes, new-onset type 2 diabetes mellitus, and diabetic ketoacidosis, a severe and potentially fatal metabolic complication.' The worst offenders are drugs such as chlorpromazine, clozapine and olanzapine (J Clin Psychiatry, 2001; 62 [Suppl 27]: 15-26). Olanzapine, marketed as Zyprexa, is manufactured by Eli Lilly, who is currently facing class-action litigation because of the diabetes side-effect.

* Antidepressants
Selective serotonin reuptake inhibitors (SSRIs) are a relatively new class of antidepressant, of which the most well known is Prozac (fluoxetine). One of its side-effects is that it seriously interferes with glucose regulation. According to the manufacturer’s prescribing information: 'In patients with diabetes, Prozac may alter glycemic control. Hypoglycemia has occurred during therapy with Prozac, and hyperglycemia has developed following discontinuation of the drug.' Other generic names of SSRIs are citalopram, fluvoxamine, paroxetine and sertraline.

* Vaccines
A number of vaccines has been linked with diabetes, which may help to explain the increase of type 1 diabetes in children. A sharp rise in type 1 diabetes was reported after children received the Haemophilus influenzae type b (Hib) vaccination for meningitis (BMJ, 1999; 319: 1133). Similar reports occurred after BCG vaccination in babies aged under two months (Infect Dis Clin Pract, 1997; 6: 449-54). These findings are controversial, however, as later surveys have failed to uncover any link between vaccines and diabetes (Drug Saf, 1999; 20: 207-12; Pediatrics, 2001; 108: E112).

* Alcohol
A recent medical survey reports that 'long-term exposure to alcohol is associated with an improvement in insulin sensitivity'. The report also reveals that 'a substantial number of prospective studies point to a protective role for light to moderate chronic alcohol intake against the development of diabetes' (J Cardiovasc Risk, 2003; 10: 25-30), a happy conclusion that Michel Montignac - as a true wine-loving Frenchman - heartily endorses.