Endocrine Abstracts

JOINT1476

Background: Daily recombinant GH (rGH) is approved for children with GH deficiency, but daily injections can be painful and stressful, leading to poor adherence. Long-acting GH analogues (LAGH), given their weekly administration, can improve patient acceptance and tolerance. However, the loss of physiological GH peaks could have a metabolic impact, especially in terms of glucose homeostasis. Though data from regulatory studies are reassuring in terms of insulin resistance and diabetes occurrence, up to now no data are available on subtle glycaemic changes in patients on either daily GH or weekly analogues.

Aims: The present study aims to provide insight into glycaemic variability differences in patients with GH deficiency (GHD) shifting from daily rGH to weekly LAGH subcutaneous injections.

Methods: For this purpose, a feasible non-invasive method which allows 24-hours continuous glucose monitoring (CGM) -Dexcom G7®System (Dexcom, Inc., San Diego, CA, USA)-, has been applied to 4 GHD children (M/F 3/1, chronological age 13. 9 years, IQR 11. 1-15. 3) in order to compare glycaemic variability differences when shifting from rGH (time 1) to LAGH (time 2). All patients used CGM for 10 days during rGH daily treatment and for 10 days after the third LAGH injection.

Results: The median coefficient of variation (CV) of patients under daily rGH treatment was not significantly different from CV under LAGH (13. 1%, IQR 11. 7-14. 7 vs 14. 2%, IQR 12. 2-14. 7). The Wilcoxon signed-rank test showed no significative difference in CV when patients switched from one formulation to the other. Specifically, no difference was observed between the two treatments during the nocturnal recording, when the highest GH peak, absent with LAGH therapy, naturally occurs.

Conclusions: This represents the first case series evaluating subtle glucose changes during GH replacement therapy by means of a non-invasive reliable tool, focusing on LAGH analogues vs daily rGH. No significant differences in glycaemic variability have been found when switching from daily to weekly injections. These preliminary results, though should be confirmed on a larger scale, are quite reassuring on LAGH safety in terms of glucose homeostasis.