Abstract
We read with interest the review article by Chrétien et al, "Comparative study of hypoglycemia induced by opioids. Is it a class effect?" published online in this journal.
The authors performed a disproportionality analysis in the WHO global individual case safety report database and in the French PharmacoVigilance DataBase (FPVD) with nine opioids (codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, tramadol, buprenorphine, and nalbuphine) looking for any indications of hypoglycemia. The authors concluded that this work highlighted a significant association between all opioids and hypoglycemia, thereby indicating that opioid-induced hypoglycemia is probably a class effect.
Women and diabetics seem to be more at risk for developing opioid-induced hypoglycemia. We think a detailed analysis of hypoglycemic events related not only to tramadol in nondiabetic subjects would be a much more valuable support to the authors' conclusions (we presume that the remaining 48 cases are related to non-diabetic patients).
It would be interesting to know the hypoglycemia definition used in those cases, the value of hypoglycemia and concomitant diseases, especially those which could contribute to hypoglycemia like renal and liver diseases, if such data are available.