Glycosaminoglycans use and hyperglycaemia

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Sir, Glucosaminoglycans are effective in knee pain related to osteoarthritis. One of the side effects associated with glucosaminoglycans is dysglycaemia and impaired glucose tolerance. A 67-year-old retired policeman, with known type 2 diabetes on diet control, presented with osmotic symptoms (increased thirst and urination) and raised blood glucose, in March 2018 in the medical assessment unit. He had started taking over-the-counter glycosaminoglycans (the glycosaminoglycans were available on a supermarket shelf) for knee pain around Christmas time 2017, and his osmotic symptoms correlated with starting on glycosaminoglycans administration. He had stopped taking glycosaminoglycans two weeks before being seen in the medical assessment unit. When seen in the unit, his HbA1c was 95mmol/mol. Previously, his HbA1c from June 2014 up to October 2017 had been varying between 45mmol/mol and 67mmol/mol. After he was seen in the medical assessment unit and when it was ensured he was not in diabetic ketoacidosis, he was advised to stay off the glycosaminoglycans and he was followed up in the diabetic clinic. His subsequent HbA1c two months later in May 2018 had improved to 77mmol/mol and, after three months, had further improved to 44mmol/mol. He was seen in the diabetic clinic and was advised about the importance of a healthy life style and its benefits. Glycosaminoglycans are long, unbranched polysaccharides composed of repeating disaccharide units consisting of alternating uronic acids and amino sugars.1 Several randomised controlled trials2, 3 have proved their efficacy in controlling pain and in improving knee function. Glycosaminoglycans are readily available over the counter and are taken by many. In presenting this case, we aim to raise awareness of raised blood sugars associated with glucosaminoglycans. Monitoring is required for patients with impaired glucose tolerance. The frequency of diabetes is not known. Of note: a detailed search in PubMed, Medline and Google Scholar did not reveal any case examples of glucosaminoglycans and their association with dysglycaemia. There are no conflicts of interest declared.

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