Glucose Metabolism in Children With Growth Hormone Deficiency

Abstract

BackgroundThe growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis has a fundamental impact on glucose metabolism. Therefore, both untreated GH deficiency (GHD) and GH treatment (GHT) may be associated with some metabolic alterations, although the abnormalities of glucose metabolism have been investigated by relatively few studies as main outcomes.AimThe present review summarizes the available data on glucose metabolism in children with GHD, providing an overview of the current state of the art in order to better clarify the real metabolic impact of GHD and GHT.MethodsAmong all the existing studies, we evaluated all original studies that fulfilled our criteria for analysis reporting parameters of glucose metabolism as the primary or secondary objective.ResultsThe reported impact of GHD per se on glucose metabolism is quite homogeneous, with the majority of studies reporting no significant difference in metabolic parameters between GHD children and controls. Conversely, GHT proves to be more frequently associated with a subtle form of insulin resistance, while both fasting glucose and HbA1c levels remain almost always within the normal range.ConclusionThe different methods to study glucose metabolism, the heterogeneity of the populations evaluated, the different doses of GH used together with the variable duration of follow-up may be responsible for discrepancy in the results. Long-term longitudinal studies having glucose homeostasis as their primary outcome are still needed in order better to clarify the real metabolic impact of GHD and GHT in children.

Glucose Metabolism Evaluated by Glycated Hemoglobin and Insulin Sensitivity Indices in Children Treated with Recombinant Human Growth Hormone

“…Several other studies have investigated the effects of rhGH therapy on glucose metabolism in children (17,18,19,20,21,22). Nevertheless, as highlighted in a recent systematic review (8), only in relatively few studies glucose metabolism abnormalities were the main outcome. The use of different methods to study glucose metabolism and the heterogeneity of the populations evaluated precluded the possibility of obtaining strong evidence of possible glycemic alterations caused by rhGH.…”

“…In recent years, a variety of different parameters and indices have been used to study the influence of GH treatment on glucose and insulin homeostasis (8). Biomarkers such as glycated hemoglobin A1c (HbA1c) and indices of glucose tolerance are now widely employed in the diagnosis and monitoring of patients with glucose abnormalities, but only one report explored their potential application in the field of rhGH therapy over a one year follow-up period (9).…”

The Interplay Between Pituitary Health and Diabetes Mellitus – The Need for ‘Hypophyseo-vigilance’

“…In a recently published review, the authors found that in the majority of studies, GH treatment in children resulted in a subtle form of insulin resistance, though FPG and glycated haemoglobin (HbA1c) mostly remained in the normal range. 43 New onset T2DM rarely occurs during GH treatment in children with GH deficiency or even with idiopathic short stature. 44 Those with Turner syndrome and children who are small for gestational age, have a higher lifetime chance of developing T2DM compared with the background population, but GH therapy in such children does not alter the incidence of T2DM in short term.…”

Glucose Metabolism Evaluated By Glycated Hemoglobin And Insulin Sensitivity Indexes In Children Treated With Recombinant Human Growth Hormone

“…Several other studies have investigated the effects of rhGH therapy on glucose metabolism in children (17)(18)(19)(20)(21)(22). Nevertheless, as highlighted in a recent systematic review (8), only in relatively few studies glucose metabolism abnormalities were the main outcome. The use of different methods to study glucose metabolism and the heterogeneity of the populations evaluated, precluded the possibility to obtain strong evidence on possible glycemic alterations caused by rhGH.…”

“…Concerning insulin sensitivity, GH treatment leads to a compensatory increase in insulin secretion before the appearance of overt glucose abnormalities (1), so decreased insulin sensitivity may be detected even without changes in glucose tolerance (7). In recent years, a variety of different parameters and indexes have been used to study the influence of GH treatment on glucose and insulin homeostasis (8). Biomarkers as glycated hemoglobin (HbA1C) and indexes of glucose tolerance are now widely employed in the diagnosis and monitoring of patients with glucose abnormalities, but only one report explored their potential application in the field of rhGH therapy over a short follow-up period (9).…”