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George I. Varughese, MRCPI, MRCP; Abd A. Tahrani, MD, MRCP; John H. B. Scarpello, MD, FRCP

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Barzilay et al¹ demonstrate that mean fasting glucose (FG) levels increased during follow-up in all treatment groups within the ALLHAT substudy observed over a mean duration of 4.9 years. At year 2, those randomized to the chlorthalidone group had the greatest increase in FG level (+ 8.5 mg/dL vs + 5.5 mg/dL in the amlodipine subgroup and + 3.5 mg/dL in the lisinopril subgroup). They conclude that for those taking chlorthalidone vs other medications, the risk of developing FG levels higher than 125 mg/dL is modestly greater, but there is no conclusive or consistent evidence that this diuretic-associated increase in risk for diabetes mellitus (DM) increases the risk of clinical events.¹ This has to be interpreted very cautiously, given the role of deranged glucose metabolism and new-onset cardiac arrhythmias.^2-4

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