Background: Treatment with GH of children born SGA allows an increase in growth velocity (GV) and improves adult height. Increased insulin resistance has been described in these patients, which reverts after interrupting GH administration. However, long-term metabolic consequences are not clearly established.
Objective and hypotheses: Describe insulin resistance (HOMA-IR index) and auxological development (GV and height) in SGA children treated with GH for 5 years, and analyse the influence of the pubertal status (PS).
Method: Prospective observational study of 407 SGA subjects treated with GH (Saizen®) for up to 5 years, determining the HOMA-IR index, GV, height, and PS annually.
Results: Baseline HOMA-IR was 1.2 (1.5), where Tanner I children had lower values than Tanner ≥II (1.2 (1.6) vs. 2.0 (0.7)), as reported in normal population (Tanner I: 1.01.5 and Tanner ≥II: 2.02.8)) (Cuartero 2007). HOMA-IR increased to 2.8 (2.8) in the fifth year, above normality in both PS groups (2.2 (1.0) vs. 3.3 (3.7)). GV and height difference (HSDS) were the highest during the first year of treatment tending to approach the reference value. Four adverse events were detected, including one event of type 2 diabetes mellitus in patient without medical history of glucose intolerance. No events were associated with insulin insensitivity.
|HOMA-IR||HOMA-IR by PS|
|Visit||All children||n||Tanner I||Tanner ≥II|
Conclusion: Treatment with GH during 5 years increased GV, reducing the height differences presented by SGA children, regardless PS. HOMA-IR showed an increase during the 5 years, with slightly higher values than in normal population. This study demonstrated efficacy of GH treatment in children SGA. Insulin sensitivity should be monitored as per SmPC.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology