Impact of medications on glycemic control in type 2 diabetes

Abstract Optimal glycemic control is critical in patients with type 2 diabetes mellitus (T2DM) to prevent both acute and chronic complications. However, achieving this goal is often complicated by polypharmacy, comorbid conditions, and the use of medications that adversely influence glucose metabolism. This case report presents a 75-year-old woman with stable T2DM, hypertension, bipolar disorder, and prior cerebrovascular accidents who developed marked hyperglycemia (glycosylated hemoglobin 11.3% and random blood sugar 247 mg/dL) and accelerated hypertension (190/90 mmHg) after initiation of prednisolone, olanzapine, and chlorthalidone. This case illustrates how concomitant use of certain medications can significantly worsen glycemic control and cardiovascular status in elderly patients with T2DM. Withdrawal of the suspected drugs, optimization of antihypertensives, and intensified insulin therapy rapidly stabilized her clinical and metabolic status. This report draws attention to the subtle yet cumulative impact of pharmacotherapy on metabolic equilibrium, highlighting the need for regular medication review, individualized therapy, and vigilant monitoring in elderly patients with comorbidities.