Endocrine Abstracts (2009) 20 P546

The prevalence of diabetes mellitus in 9776 adult patients with childhood- and adult-onset growth hormone (GH) deficiency before GH replacement: a KIMS analysis

Roger Abs1, Anton Luger2, Patrick Wilton3, Maria Thunander4,5, Johan Verhelst6, Miklos Goth7, Maria Koltowska-Haggstrom8 & Anders Mattsson8

1Department of Endocrinology, University of Antwerp, Antwerp, Belgium; 2Universitätsklinik fur Innere Medizin III, Klinik Abt. fur Endokrinologie und Stoffwechsel, Vienna, Austria; 3Pfizer Endocrine Care, Pfizer Ltd, New York, New York, USA; 4Department of Internal Medicine, Central Hospital, Vaxjo, Sweden; 5Department of Diabetology and Endocrinology, Lund University, Lund, Sweden; 6Department of Endocrinology, General Hospital Middelheim, Antwerp, Belgium; 7Division of Endocrinology, Department of Medicine, National Medical Centre, Budapest, Hungary; 8KIMS Medical Outcomes, Pfizer Endocrine Care, Sollentuna, Sweden.

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):1047–1053, 2004).

Results: In CO-GHD, 42 patients (2.12%; 50% males) presented with DM vs 1.34% expected (PR=1.6 95% CI 1.15–2.15). PR was elevated in the younger age groups (10.5, 4.2 and 1.7 in the age-groups of 20–24, 25–29, and 30–39 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 1.15–1.35). 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 20–24, 25–29 30–34, 35–39, 40–44, and 45–49 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.