Background: Untreated GH-deficiency (GHD) in adults has been suggested to be associated with an increased prevalence of type 2 diabetes mellitus (DM). Proposed causative factors are the tendency to overweight and the insulin resistance due to central adiposity.
Patients and methods: The KIMS (Pfizer International Metabolic Database) was used to evaluate the prevalence of DM in both childhood-onset (CO; n=1977; 56% males) and in adult-onset (AO; n=7799; 48% males) GHD patients before start of GH replacement as adults. In adulthood, mean age at initiation of GH treatment in CO was 28 (S.D.: 11) and in AO 49 years (S.D.: 13). Observed/expected prevalence ratios (PRs) were based on 5-year age-groups. Expected prevalence was calculated with published age-specific estimates on global prevalence of diabetes (Diabetes Care, 27(5):10471053, 2004).
Results: In CO-GHD, 42 patients (2.12%; 50% males) presented with DM vs 1.34% expected (PR=1.6 95% CI 1.152.15). PR was elevated in the younger age groups (10.5, 4.2 and 1.7 in the age-groups of 2024, 2529, and 3039 years, respectively). For older age groups PRs were similar to expected. Impaired fasting glucose (IFG) was found in 60 patients (3.0%; 63% males). Mean BMI was 33.5 in DM, 26.9 in IFG, and 26.5 kg/m2 in non-diabetics.
In AO-GHD, 631 patients (8.19%; 43% males) presented with DM vs expected 6.57% (PR=1.25; 95% CI 1.151.35). PRs were elevated in age groups below 50 years (18.6, 7.0, 5.5, 2.7, 1.7 and 1.3 in age-groups of 2024, 2529 3034, 3539, 4044, and 4549 years, respectively) and similar to expected in ages above 50 years. IFG were found in 355 patients (4.6%; 46% males). Mean BMI was 33.2, 31.0 and 29.2 kg/m2 in DM, IFG, and non-diabetic patients, respectively.
Conclusions: Untreated GHD is associated with an increased prevalence of DM in both CO- and AO-GHD, predominantly in younger patients.
25 - 29 Apr 2009
European Society of Endocrinology