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Clin Toxicol (Phila). 2019 Apr;57(4):254-264. doi: 10.1080/15563650.2018.1515438. Epub 2018 Oct 11.

Short-term glucose dysregulation following acute poisoning with organophosphorus insecticides but not herbicides, carbamate or pyrethroid insecticides in South Asia.

Author information

1
a University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK.
2
b South Asian Clinical Toxicology Research Collaboration , Faculty of Medicine , University of Peradeniya , Sri Lanka.
3
c Department of Medicine, Faculty of Medicine , Chittagong Medical College , Chittagong , Bangladesh.
4
d Department of Medicine, Faculty of Medicine , Rajarata University of Sri Lanka , Saliyapura , Sri Lanka.
5
e Centre for Pesticide Suicide Prevention , University of Edinburgh , Edinburgh , UK.

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Abstract

BACKGROUND:

Ingestion of organophosphorus (OP) insecticides is associated with acute hyperglycaemia. We conducted a prospective study to determine whether glucose dysregulation on admission associated with ingestion of OP insecticides or other pesticides is sustained to hospital discharge or to 3-12 months later.

METHODS:

We recruited participants to two similar studies performed in parallel in Anuradhapura, Sri Lanka, and Chittagong, Bangladesh, following hospitalisation for OP insecticide, herbicide or other pesticide self-poisoning. Two-hour 75 g oral glucose tolerance testing (OGTT) was performed after recovery from the acute poisoning, at around the time of discharge. In Sri Lanka, a four time-point OGTT for area-under-the-curve (AUC), C-peptide and homeostatic modelling of insulin resistance (HOMA-IR) was undertaken, repeated after 1 year. In Bangladesh, a 2-h OGTT for glucose was undertaken and repeated after 3 months in participants with initial elevated 2-h glucose. We compared glucose homeostasis by poison group and adjusted findings for age, BMI and sex.

FINDINGS:

Seventy-three Sri Lankan and 151 Bangladeshi participants were recruited. We observed higher mean [SD] fasting (4.91 [0.74] vs. 4.66 [0.46] mmol/L, p = .003) and 2-h glucose (7.94 [2.54] vs. 6.71 [1.90] mmol/L, p < .0001) in OP-poisoned groups than pyrethroid, carbamate, herbicide or 'other poison' groups at discharge from hospital. In Sri Lanka, HOMA-IR, glucose and C-peptide AUC were higher in OP than carbamate or herbicide groups. Adjusted analyses remained significant except for fasting glucose. Follow-up analysis included 92 participants. There was no significant difference in OGTT results between OP-poisoned and other participants at follow-up (mean [SD] 2-h fasting glucose 4.67 [0.92] vs. 4.82 [0.62], p = .352; 2-h glucose 6.96 [2.31] mmol/L vs. 6.27 [1.86] mmol/L, p = .225).

CONCLUSION:

We found in this small prospective study that acute OP insecticide poisoning caused acute glucose dysregulation that was sustained to hospital discharge but had recovered by 3-12 months. Acute glucose dysregulation was related to defects in insulin action and secretion. This study did not address long-term risk of diabetes following acute OP insecticide poisoning, but could provide the data for a power calculation for such a study.

KEYWORDS:

Prevention of diabetes; glucose dysregulation; oral glucose tolerance test; organophosphorus pesticides; pancreatic endocrine function; pesticide poisoning

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