Law & Medicine

Diabetes-related malpractice


Litigation can be expected where diabetes is acquired following injuries to the pancreas, e.g., pancreatitis, surgery, or trauma. Medication side effects are another common source of lawsuits when they cause or aggravate diabetes. The best example is glucocorticoids, but many other drugs have been implicated, such as thiazides and beta blockers.

More recently, a flurry of lawsuits, not always successful, has alleged the development or aggravation of diabetes in patients taking antipsychotic drugs. These cases are usually directed at the manufacturer for allegedly withholding data from the FDA.

Finally, antidiabetic drugs themselves can cause serious side effects, and the injured patient may prevail if it can be shown that the drugs’ use was unwarranted, or that the side effects were not disclosed.

Examples are hypoglycemia and weight gain from insulin and sulfonylureas, as well as other less common but important side effects such as liver failure from troglitazone (Rezulin, withdrawn from the market in 2000), coronary artery disease from rosiglitazone, bladder cancer from pioglitazone, pancreatitis from incretin mimetics or DPP-4 inhibitors, and lactic acidosis from metformin.

The list is not exhaustive, and doctors should consult the PDR or other drug sources for information and updates.

Medication-induced hypoglycemia can lead to driving accidents. The patient who is not warned of such a risk can sue the doctor for lack of informed consent. Furthermore, notwithstanding absence of the traditional doctor-patient relationship, an injured nonpatient third party may allege that a "special relationship" exists if the injury is foreseeable (Internal Medicine News, January 2013, p. 53).

A questionnaire survey of patients in U.S. and European diabetes clinics revealed that half of type 1 diabetes patients who drove and three-quarters of type 2 diabetes patients who drove purportedly never had a discussion with their physicians regarding hypoglycemia and driving. In that study, type 1 patients but not type 2 patients – including those on oral agents or insulin – had more driving mishaps than their nondiabetic spouses (Diabetes Care 2003;26:2329-34).

Dr. Tan is emeritus professor of medicine and a former adjunct professor of law at the University of Hawaii. This article is meant to be educational and does not constitute medical, ethical, or legal advice. It is adapted from the author’s book, "Medical Malpractice: Understanding the Law, Managing the Risk" (2006). For additional information, readers may contact the author at This column, "Law & Medicine," appears regularly in Internal Medicine News.

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