Long acting somatostatin analogues (SSA) such as Sandostatin LAR and Lanreotide Autogel are the most commonly used drugs in the management of neuroendocrine tumours (NETs) due to their ability to control symptoms and prolong survival. SSAs use is associated with changes in glucose metabolism. However, there is lack of data for such effects in patients with NETs. We evaluated the effects of SSA on BMI and HbA1c in our cohort of patients with NETs.
Methods: A retrospective study of 279 patients with NETs who are were treated with SSA. The study period was between January 2014 and January 2019. We assessed changes in BMI and HbA1c before and after SSA treatment. HbA1c and BMI results before and after SSA therapy were compared using the dependent T-test. We also assessed the incidence of new diabetes within the population or whether there was worsening of diabetes control for patients with pre-existing diabetes. We also assessed whether the duration of treatment had any impact on BMI or HbA1c.
Results: We found a significant increase in HbA1c of 3.35 mmol/mol (S.D. ±6.30) but a significant decrease in BMI of −1.04 kg/m2 (S.D.±2.79). There were 19 new cases of type 2 diabetes mellitus in the population of 238 eligible for analysis giving an incidence rate of 7.98 per 100 and a number needed to harm of 12.5. Of the 34 patients who were already diabetic, 8 had worsening of their diabetic control. There was a statistically significant linear relationship between duration of treatment and BMI (correlation coefficient −0.12). There was also a significant positive linear relationship between duration of treatment and HbA1c (correlation coefficient +0.08).
Discussion: Despite the weight loss observed in the study, treatment with SSAs caused a rise in HbA1c, highlighting the impact SSAs may have on glucose regulation. Duration of treatment had little impact on BMI and HbA1c changes suggesting all patients using SSA are at risk.
Conclusions: Treatment with SSAs for NETs is associated with rise in HbA1c and new cases of type 2 diabetes mellitus. Duration of treatment has minimal effect on the changes in BMI or HbA1c.
02 Dec 2019
UK and Ireland Neuroendocrine Tumour Society