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Incidence of Diabetes Mellitus and Evolution of Glucose Parameters in Growth Hormone-Deficient Subjects During Growth Hormone Replacement Therapy A long-term observational study

Luger, Anton; Mattsson, Anders F.; Koltowska-Haggstrom, Maria; Thunander, Maria LU ; Goth, Miklos; Verhelst, Johan and Abs, Roger (2012) In Diabetes Care 35(1). p.57-62
Abstract
OBJECTIVE Growth hormone (GH) deficiency is associated with insulin resistance and diabetes. The aim of the current study was to determine incidence of diabetes during GH replacement therapy (GHRT) and the effect of GHRT on fasting plasma glucose concentrations and HbA(1c) in adult patients with GH deficiency. RESEARCH DESIGN AND METHODS-A total of 5,143 GH-deficient patients (male 49.9%; mean age +/- SD, 49 +/- 1.3 years; BMI 29.1 +/- 5.9 kg/m(2)) were analyzed. Mean observation period was 3.9 years (range 0.01-13). Total number of patient-years was 20,106. Observed number of cases (O) was compared with expected number of cases (E). Reference rates were from Sweden, three additional European regions, and one U.S. region. RESULTS Patients... (More)
OBJECTIVE Growth hormone (GH) deficiency is associated with insulin resistance and diabetes. The aim of the current study was to determine incidence of diabetes during GH replacement therapy (GHRT) and the effect of GHRT on fasting plasma glucose concentrations and HbA(1c) in adult patients with GH deficiency. RESEARCH DESIGN AND METHODS-A total of 5,143 GH-deficient patients (male 49.9%; mean age +/- SD, 49 +/- 1.3 years; BMI 29.1 +/- 5.9 kg/m(2)) were analyzed. Mean observation period was 3.9 years (range 0.01-13). Total number of patient-years was 20,106. Observed number of cases (O) was compared with expected number of cases (E). Reference rates were from Sweden, three additional European regions, and one U.S. region. RESULTS Patients who developed diabetes (n = 523) were older; had higher BMI, waist circumference, triglyceride concentrations, and blood pressure; and had lower HDL-cholesterol concentrations (P < 0.0001) than those who did not develop diabetes. Diabetes incidence was 2.6 per 1.00 patient-years, equal in both sexes, and significantly increased compared with the Swedish reference (O/E = 6.02; P < 0.0001) as well as with the four other populations (O/E = 2.11-5.22). O/E increased with BMI and decreased with duration of GHRT (P < 0.0001). There was no significant association with GH dose (P = 0.74) or IGF-1 SDS (P = 0.47). In subjects not developing diabetes, plasma glucose concentrations increased from 84.4 +/- 0.9 mg/dL to 89.5 +/- 0.8 mg/dL (0.70 mg/dL/year) and HbA(1c) increased from 4.74 +/- 0.04% to 5.09 +/- 0.13% (0.036%/year) after 6 years of GHRT. CONCLUSIONS-Diabetes incidence appears to be increased in GH-deficient patients receiving GHRT and exhibiting an adverse risk profile at baseline. Therefore, glucose homeostasis parameters should be monitored carefully in these patients. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Diabetes Care
volume
35
issue
1
pages
57 - 62
publisher
American Diabetes Association
external identifiers
  • wos:000298771900011
  • scopus:84859031893
ISSN
1935-5548
DOI
10.2337/dc11-0449
language
English
LU publication?
yes
id
23c389f7-c398-4a0b-9529-157750714c8e (old id 2333866)
date added to LUP
2012-02-01 07:41:10
date last changed
2017-10-22 04:05:03
@article{23c389f7-c398-4a0b-9529-157750714c8e,
  abstract     = {OBJECTIVE Growth hormone (GH) deficiency is associated with insulin resistance and diabetes. The aim of the current study was to determine incidence of diabetes during GH replacement therapy (GHRT) and the effect of GHRT on fasting plasma glucose concentrations and HbA(1c) in adult patients with GH deficiency. RESEARCH DESIGN AND METHODS-A total of 5,143 GH-deficient patients (male 49.9%; mean age +/- SD, 49 +/- 1.3 years; BMI 29.1 +/- 5.9 kg/m(2)) were analyzed. Mean observation period was 3.9 years (range 0.01-13). Total number of patient-years was 20,106. Observed number of cases (O) was compared with expected number of cases (E). Reference rates were from Sweden, three additional European regions, and one U.S. region. RESULTS Patients who developed diabetes (n = 523) were older; had higher BMI, waist circumference, triglyceride concentrations, and blood pressure; and had lower HDL-cholesterol concentrations (P &lt; 0.0001) than those who did not develop diabetes. Diabetes incidence was 2.6 per 1.00 patient-years, equal in both sexes, and significantly increased compared with the Swedish reference (O/E = 6.02; P &lt; 0.0001) as well as with the four other populations (O/E = 2.11-5.22). O/E increased with BMI and decreased with duration of GHRT (P &lt; 0.0001). There was no significant association with GH dose (P = 0.74) or IGF-1 SDS (P = 0.47). In subjects not developing diabetes, plasma glucose concentrations increased from 84.4 +/- 0.9 mg/dL to 89.5 +/- 0.8 mg/dL (0.70 mg/dL/year) and HbA(1c) increased from 4.74 +/- 0.04% to 5.09 +/- 0.13% (0.036%/year) after 6 years of GHRT. CONCLUSIONS-Diabetes incidence appears to be increased in GH-deficient patients receiving GHRT and exhibiting an adverse risk profile at baseline. Therefore, glucose homeostasis parameters should be monitored carefully in these patients.},
  author       = {Luger, Anton and Mattsson, Anders F. and Koltowska-Haggstrom, Maria and Thunander, Maria and Goth, Miklos and Verhelst, Johan and Abs, Roger},
  issn         = {1935-5548},
  language     = {eng},
  number       = {1},
  pages        = {57--62},
  publisher    = {American Diabetes Association},
  series       = {Diabetes Care},
  title        = {Incidence of Diabetes Mellitus and Evolution of Glucose Parameters in Growth Hormone-Deficient Subjects During Growth Hormone Replacement Therapy A long-term observational study},
  url          = {http://dx.doi.org/10.2337/dc11-0449},
  volume       = {35},
  year         = {2012},
}