ESPE Abstracts

Introduction: It is thought that long-term growth hormone (GH) treatment may impair hepatic glucose production and insulin-dependent glucose utilization, and therefore it is attributed that GH may adversely affect glucose metabolism.

Objective: In our study, we aimed to examine the effects of GH treatment on insulin sensitivity and glucose metabolism in patients with GH deficiency after 1-year of treatment.

Methods: 59 patients (22 female) who were diagnosed with GH deficiency with two stimulation tests and received GH treatment were included in the study. Patients who were born small for gestational age, had chronic diseases and were using drugs other than GH were excluded from the study. Anthropometric measurements and pubertal examinations of the patients were done. Baseline and first year fasting plasma glucose (FPG), insulin, HbA1c levels were checked and oral glucose tolerance test (OGTT) (1.75 g/kg, max. 75 g) was performed. HOMA-IR and Matsuda indices were calculated.

Results: The mean age of the patients at the initiation of GH treatment was 11.6±2.6 years old. Height SDS of the patients was low, body mass index (BMI) SDS was normal. Before treatment, FPG, fasting insulin, HbA1c and c-peptide levels were normal. HOMA-IR was 2.7±1.6, Matsuda-ISI was 5.8±5.6. At the end of the first year, the mean age was 13.1±2.5 years. Height SDS improved, BMI SDS was similar compared to pretreatment. There was no significant difference between the pre-treatment and first year puberty stages of the patients. At the end of the first year, FPG and HbA1c levels were normal. HOMA-IR was 3.2±2.5, Matsuda-ISI was 5.6±8.2. When the values of the pre-treatment and the first year were compared; fasting insulin, peak insulin, total insulin were significantly higher after GH treatment (P=0.037; 0.05; 0.017); Matsuda-ISI was found to be significantly lower (P=0.009). Although the first year HOMA-IR levels were high, we did not detect any significance.

Conclusion: We observed that short-term GH treatment caused an increase in insulin resistance, but this increase did not reach disease-causing levels. It is important to monitor children receiving GH treatment for insulin resistance. OGTT is a reliable method in these patients; and we recommend to evaluate fasting, peak and total insulin levels and to calculate the HOMA-IR and Matsuda-ISI. We recommend to follow-up patients after treatment discontinuation, since insulin resistance can be reversible.