Glycometabolic control in acromegalic patients with diabetes: a study of the effects of different treatments for growth hormone excess and for hyperglycemia.

Abstract

BACKGROUND:

Diabetes mellitus is frequently observed in patients with acromegaly. Current therapies for acromegaly may impact glucose regulation, influencing insulin sensitivity and secretion. The question whether these therapies modify control and progression of diabetes once present is still open.

AIM:

Aim of our study is to analyze glucose control in acromegalic patients with diabetes, evaluating the relation with treatments for GH excess and for diabetes.

METHODS:

Seventy patients with acromegaly and diabetes were studied. Duration and treatments of acromegaly and diabetes were recorded, together with clinical and metabolic parameters.

RESULTS:

Most patients (92.8%) were treated with somatostatin analogs (SSA), either alone or in combination with dopamine-agonists (20%) or pegvisomant (15.7%); 7.1% of patients had been treated by surgery alone. Metformin (65.7%), alone or in combination with other hypoglycemic drugs, was the most frequent treatment for diabetes, followed by insulin (21.5%). Only 15.7% were treated with diet alone. The whole cohort showed a very good control of diabetes and acromegaly. Median glycated hemoglobin was 6.4% (5.9-7). IGF-I was within normal range for age in most patients. No relation was observed between duration of acromegaly or diabetes and metabolic control. SSA had a negative effect on insulin secretion, but these effects did not influence glucose control. Finally, we observed a low prevalence of nephropathy (6%) and retinopathy (20%).

CONCLUSIONS:

Our study shows that a good control of hyperglycemia can be obtained with success in the majority of acromegalic patients with diabetes, independently of the type of treatment for GH excess.

• Authors: V M Cambuli, M Galdiero, M Mastinu, F Pigliaru, R S Auriemma, A Ciresi, R Pivonello, M Amato, C Giordano, S Mariotti, A Colao, M G Baroni
• Journal: Journal of endocrinological investigation (J Endocrinol Invest) Vol. 35 Issue 2 Pg. 154-9 (Feb 2012) ISSN: 1720-8386 [Electronic] Italy
• PMID: 21532330 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Dopamine Agonists
• Glycated Hemoglobin A
• hemoglobin A1c protein, human
• Human Growth Hormone
• Somatostatin

Topics

• Acromegaly (blood, complications, metabolism, therapy)
• Aged
• Blood Glucose (drug effects, metabolism)
• Cohort Studies
• Diabetes Complications (blood, metabolism, therapy)
• Diabetes Mellitus (blood, metabolism, therapy)
• Dopamine Agonists (therapeutic use)
• Endocrine Surgical Procedures
• Glycated Hemoglobin (metabolism)
• Human Growth Hormone (blood)
• Humans
• Hyperglycemia (blood, metabolism, therapy)
• Middle Aged
• Somatostatin (analogs & derivatives, therapeutic use)