• Jill J Hall, Dean T Eurich, Danielle Nagy, Lisa Tjosvold, and John-Michael Gamble.
• Faculty of Pharmacy and Pharmaceutical Sciences, 3-236 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada. jhall@ualberta.ca.
• J Gen Intern Med. 2020 Jun 1; 35 (6): 184918601849-1860.

BackgroundPrior meta-analyses measuring thiazide-induced glycemic change have demonstrated an increased risk of incident diabetes; however, this measure's definition has changed over time.AimTo determine the magnitude of change in fasting plasma glucose (FPG) for thiazide diuretics.Data SourcesA research librarian designed and conducted searches in Medline®, EMBASE, and EBM Reviews-Cochrane Central Register of Controlled Trials (inception through July 2018) and International Pharmaceutical Abstracts (inception to December 2014).Study SelectionRandomized, controlled trials comparing a thiazide or thiazide-like diuretic to any comparator reporting FPG were identified. Trials enrolling < 50 participants, those with a follow-up period of < 4 weeks, and conference abstracts were excluded.Data ExtractionIndependent duplicate screening of citations and full-text articles, data extraction, and assessment of risk of bias was conducted.Data SynthesisNinety-five studies were included (N = 76,608 participants), with thiazides compared with placebo, beta-blockers, calcium channel blockers, renin-angiotensin-aldosterone-system inhibitors, potassium-sparing diuretic, and others alone or in combination. Thiazide diuretics marginally increased FPG (weighted mean difference 0.20 mmol/L (95% CI 0.15-0.25); I2 = 84%) (1 mmol/L = 18 mg/dL). Results did not change substantially when considering dose or duration, comparing thiazides with placebo or an active comparator, or using thiazides as monotherapy or combination therapy, even when combined with a potassium-correcting agent.ConclusionThiazide diuretics have a small and clinically unimportant impact on FPG.

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