Thursday, January 19, 2012

GH replacement therapy associated with development of diabetes

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Luger A. Diabetes Care. 2012;35:57-62.


The incidence of diabetes was increased in patients with growth hormone deficiency who were on growth hormone replacement therapy, according to researchers in Europe.

The researchers selected patients from KIMS — Pfizer International Metabolic Database. Patients were selected if they had severe adult-onset GH deficiency that was confirmed with a GH stimulatory test and naive to GH treatment. Patients with a history of Cushing’s disease or acromegaly or with diabetes at baseline were excluded.


The study included data from 5,143 patients. Plasma glucose, HbA1c values, lipid and insulin-like growth factor I concentrations and serum IGF-I measurements were obtained.

Five hundred twenty-three patients developed diabetes after a median of 1.7 years. Patients who developed diabetes were older, had higher BMI, waist circumference, waist-to-hip ratio and triglyceride concentrations. They also had higher systolic and diastolic blood pressure and lower HDL cholesterol.

The incidence of diabetes was 2.6/100 patient-years, decreasing from 4.1/100 patient-years during the first year of GH replacement therapy to 1/100 patient-years after more than 8 years of treatment. The overall observed cases/expected cases ratio was 6, decreasing from 10.8 in the first year of treatment to 1.9 after 8 or more years of treatment.

Sex, BMI, attained age during follow-up, years between pituitary diagnosis and GH treatment start and years since first treatment were significantly associated with diabetes occurrence. There was no significant association with GH dose. In patients who did not develop diabetes, plasma glucose concentrations increased from 84.4 mg/dL to 89.5 mg/dL, and HbA1c levels increased from 4.74% to 5.09% after 6 years of treatment.

“Despite widely demonstrated benefits of growth hormone replacement treatment in adult growth hormone deficiency, a marked increase in the risk of developing diabetes must be considered,” the researchers wrote. “All patients, but particularly those with an adverse risk profile, should be carefully followed regarding parameters of glucose metabolism.”