Colchicine-Associated Hypoglycemia in Diabetic Dialysis Patients: Observations from a Tanzanian Dialysis Unit: a case reports

Background: Colchicine is widely used for the treatment of acute gout flares due to its anti-inflammatory properties. Beyond this traditional role, colchicine has been implicated in modulating various physiological systems, including glucose metabolism. Notably, it exhibits a biphasic effect on blood glucose levels causing hypoglycemia at lower doses and hyperglycemia at higher doses. However, its impact on glycemic control in diabetic patients undergoing dialysis remains poorly characterized. Case Reports: We report two cases from the Dialysis Unit at Kilimanjaro Christian Medical Centre (KCMC) in northern Tanzania involving two Black African diabetic males aged 66 and 62 years with end-stage renal disease (ESRD) on maintenance hemodialysis. Both patients experienced a notable and reproducible decline in blood glucose levels following colchicine administration for gout flares. The hypoglycemia occurred in the absence of other identifiable precipitating factors and resolved upon withholding colchicine. Discussion: These observations raise important questions regarding the potential glucose-lowering effects of colchicine in dialysis dependent diabetic patients. The exact mechanism remains unclear but may involve colchicine’s influence on insulin sensitivity, hepatic glucose production, or inflammatory pathways that indirectly affect glucose metabolism. Given the already high risk of hypoglycemia in ESRD patients, these findings warrant careful consideration and further investigation. Conclusion: Colchicine may have an under recognized hypoglycemic effect in diabetic patients undergoing dialysis. Clinicians should be alert to this potential interaction, particularly in patients with poor glycemic reserve. Further research is needed to elucidate the mechanisms involved and assess whether colchicine could be repurposed as an adjunctive agent for glycemic control in selected ESRD populations.