Fasting blood glucose, OGTT... Before doing these tests, ask about the use of the following drugs!

*Only for medical professionals to read for reference.
OGTT is inaccurate, it may be affected by the drug! Diabetes is an absolute or relatively insufficient insulin secretion, which causes progressive disorders of sugar, fat, protein, water, and electrolytes, with hyperglycemia as the main marker
.

The screening indicators include fasting blood glucose, oral glucose tolerance test (OGTT) and so on
.

Aldosterone (primary aldosteronism) is a salt-sensitive hypertension in which the adrenal cortex spontaneously secretes too much aldosterone, which causes the body to retain sodium, increase blood volume, and inhibit the secretion of renin.
The clinical features are hypertension and hypertension.
Aldosterone, low renin
.

The primary indicator for screening is the ratio of plasma aldosterone to renin (ARR)
.

So, which drugs have an effect on fasting blood glucose and OGTT? What drugs have an impact on ARR screening? Let’s take a look today.
Before doing these endocrine tests, we must ask which drugs have been used.
.
.
01 Fasting blood glucose Fasting blood glucose is an important indicator for measuring pancreatic islet function (basic secretion), and it is also an important reference for the diagnosis of diabetes.
The following drugs It may affect the detection of fasting blood glucose
.

(1) Insufficient dosage of ultra-long-acting insulin (providing basal insulin action) used by diabetes patients, or insufficient oral hypoglycemic drugs at night, resulting in blood sugar levels after dinner have been higher than normal, and continued until early morning, which can cause fasting Elevated blood sugar
.

Overdose of long-acting oral hypoglycemic drugs taken at night can cause hypoglycemia at night or in the early morning.
After the body regulates itself by blood glucose-increasing hormones (epinephrine, glucagon, glucocorticoids, etc.
), it can cause fasting blood sugar rise at dawn and early morning.
High
.

In addition, due to the inability to eat during the physical examination, the hypoglycemic drugs that need to be used before meals, such as rapid-acting insulin and glinide drugs, should be suspended.
The above-mentioned drugs must be taken with meals.
If not eaten immediately, severe hypoglycemia may occur
.

It can be used after the blood draw and before eating
.

(2) Non-hyperglycemic drugs Quinolones, diuretics, levothyroxine, glucocorticoids, etc.
can increase blood sugar, but the increase in blood sugar caused by the use of glucocorticoids in the morning is often manifested as an increase in blood sugar after lunch
.

Oral glucose tolerance test (OGTT) If fasting blood glucose or abnormal blood glucose at any point (fasting blood glucose ≥ 6.
1 mmol/L or any point blood glucose ≥ 7.
8 mmol/L), but does not meet the diagnostic criteria for diabetes, OGTT (fasting blood glucose and glucose load) is recommended After 2h blood glucose), the state of glucose metabolism can be clarified
.

Discontinue drugs that may affect OGTT, such as contraceptives, diuretics, or phenytoin, for 3-7 days before the test
.

Aldosterone to renin ratio (ARR) (1) Antihypertensive drugs such as calcium channel blockers (CCB), angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARB), diuretics, Beta blockers, alpha 1 blockers
.

①Calcium channel blockers (CCB) dihydropyridine CCBs such as nifedipine can increase plasma renin activity and reduce aldosterone synthesis, but it has also been reported that it has little effect on plasma aldosterone concentration and may reduce ARR (false negatives may be )
.

Non-dihydropyridine CCBs, such as sustained-release verapamil and diltiazem, basically do not affect plasma renin activity and aldosterone concentration, and can be used for those who need to detect ARR but cannot stop antihypertensive drugs
.

②ARB/ACEIARB and ACEI can increase plasma renin activity and reduce plasma aldosterone concentration, resulting in a decrease in ARR and the possibility of false negatives
.

③Diuretics thiazide diuretics can cause hypokalemia and low volume, can activate the renin-angiotensin-aldosterone system (RAAS), increase plasma renin activity and plasma aldosterone concentration; aldosterone receptor antagonists spironolactone, Pristine can increase plasma renin activity and plasma aldosterone concentration
.

Because potassium-sparing/potassium-expelling diuretics stimulate plasma renin activity more than plasma aldosterone concentration, it can reduce ARR and cause false negatives
.

④ β-receptor blockers β-receptor blockers inhibit plasma renin activity significantly more than the inhibition of plasma aldosterone concentration, which can increase plasma ARR and cause false positives
.

⑤α1 receptor blockers such as terazosin, doxazosin, etc.
have little effect on RAAS, and can be used for those who need to detect ARR but cannot stop antihypertensive drugs, but they can increase heart rate and can be combined with sustained-release vitamins if necessary.
Combined with Lapami
.

⑥ Central antihypertensive drugs such as clonidine can inhibit RAAS and reduce renin secretion, and the inhibition of plasma renin activity is significantly greater than the inhibition of plasma aldosterone concentration, which can increase ARR and cause false positives
.

(2) Non-hypertensive drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and licorice preparations
.

①Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs inhibit plasma renin activity significantly more than they inhibit plasma aldosterone concentration, which can increase ARR and cause false positives.
Therefore, the drug needs to be discontinued before determining ARR
.

②Although low potassium of licorice preparation has little effect on plasma renin activity or slightly stimulates it, it can inhibit plasma aldosterone concentration, reduce ARR, and cause false negatives
.

Because licorice preparation has the effect of lowering blood potassium, it is necessary to stop using it for more than 4 weeks before measuring ARR
.

Table 1 Recommendations for the application of primary aldehyde screening drugs, classification recommendations, recommendations, points of attention Dihydropyridine CCB amlodipine, benidipine: used for non-dihydropyridine CCB intolerance before the user has been used before screening, can continue Drug screening, if the ARR is greater than the threshold, continue follow-up inspections
.

Non-dihydropyridine CCB verapamil, diltiazem: It is recommended to have an inhibitory effect on the cardiac conduction system
.
It is forbidden for people with second or third degree atrioventricular block and cardiac insufficiency .

ACEI/ARB preferentially recommends that the drug still cannot control the blood pressure and has been used before the screening, but the drug screening can not be stopped.
If the ARR is greater than the threshold, the follow-up inspection will continue
.

Diuretics Potassium-sparing/potassium excretion diuretics: loop diuretics, thiazide diuretics, spironolactone, eplerenone, amiloride, triamterene, not recommended, stop the drug for ≥4 weeks before screening and pay attention to electrolytes And kidney function
.

β-blockers metoprolol, bisoprolol, carvedilol: not recommended, patients with cardiac insufficiency or coronary heart disease should not stop the drug suddenly if the drug is stopped for ≥ 2 weeks before screening
.

α1-receptor blockers terazosin, doxazosin, etc.
: Recommended first, can be combined with non-dihydropyridine CCB to have adverse reactions of orthostatic hypotension, the first dose is halved, and taken at night before going to bed
.

The elderly, orthostatic hypotension, and cardiac insufficiency should be used with caution
.

Central antihypertensive drugs Clonidine and methyldopa: Not recommended.
Stopping the drug for ≥2 weeks before screening can easily cause a blood pressure rebound.
It is advisable to stop the drug slowly
.

Discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs) before screening for ≥2 weeks before screening of licorice preparations for ≥2 or 4 weeks before screening, outpatients usually do not stop the drug (avoid diuretics, beta blockers) ARR measured on a random basis
.

When the test results are affected by drugs, the relevant antihypertensive drugs are discontinued
.

① If the blood pressure rises slightly, consider discontinuing the antihypertensive drugs being used
.

The drug withdrawal time is different due to different drug metabolism and different levels of RAAS stimulation or inhibition
.

Generally, β-blockers, ACEI/ARB, dihydropyridine CCB, and clonidine should be stopped for more than 2 weeks, and diuretics should be stopped for more than 4 weeks
.

β-blockers and clonidine should be reduced slowly to avoid blood pressure rebound after sudden withdrawal
.

②If antihypertensive drugs should not be discontinued, it is necessary to switch to drugs with less impact on RAAS.
It is recommended that non-dihydropyridine CCB and α1 receptor blockers are the first choice
.

If it is still difficult to control blood pressure, dihydropyridine CCB, ACEI/ARB can be used appropriately, but diuretics, β-blockers, and central antihypertensive drugs should be avoided
.

References: [1] Zhu Yizheng et al.
Pharmacology [M].
Beijing: People's Medical Publishing House, 2016: 324.
[2] Guidelines for the rational use of hypertension (2nd edition) [J].
Frontier Journal of Chinese Medicine, 2017,9(7):28-70.
[3]Liu Zhijun.
"Drugs" must be cautious if you want to cure diseases[M].
Beijing: People's Medical Publishing House, 2015: 248-252.
[4] National Basic Level Diabetes Management Manual (2019)[J].
Chinese Journal of Internal Medicine,2019,58(10):713.
[5]Chinese Type 2 Diabetes Prevention Guidelines (2017 Edition)[J].
Chinese Journal of Diabetes,2018,10(1):5.