GH replacement therapy improves glycemic control in diabetic patients with adult growth hormone deficiency

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 109-133-GHRH, GH & IGF Biology & Signaling
Bench to Bedside
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-117
Michiko Kohno*, Ichiro Abe, Masahiro Adachi, Hisaya Kawate, Keizo Ohnaka, Masatoshi Nomura and Ryoichi Takayanagi
Kyushu Univ, Fukuoka, Japan
Background

Growth hormone replacement therapy (GHRT) for adult growth hormone deficiency (aGHD) has shown to reduce insulin sensitivity in several studies (1-2). Recently, it was also reported that the incidence of diabetes was increased in aGHD patients during GHRT (3). Therefore, GHRT is not recommended for aGHD with diabetes in Japan. However, other studies have shown that GHRT improved insulin sensitivity and ameliorated glucose tolerance (4-5). Conversely, aGHD itself has reported to be associated with an increased prevalence of diabetes (6), suggesting GHRT improves glucose tolerance. Collectively, it remains unclear whether GHRT has a beneficial effect on glycemic control in patients with aGHD. We therefore examined the effect of GHRT on glycemic control in patients with aGHD.

Methods

We have now studied the glucose metabolic status in 17subjects (6 women and 11 men) with aGHD who commenced GHRT between 2004 and 2012 at Kyushu University hospital. The subjects included two diabetic patients.

Results

Follow-up ranged 2-84 months (mean 21 months). The mean age of the patients was 50.2yr (range 28-77yr). The mean dosage of GH replacement was 0.21mg/day (range 0.1-0.4mg/day). The value of HbA1c during the replacement in non-diabetic patients was not significantly changed and no one developed type 2 diabetes. On the contrary, glycemic control in diabetic patients has been dramatically improved. In addition, liver dysfunction due to fatty liver was concomitantly improved and their body weights also decreased by GHRT. One of the cases of diabetic patients will be presented. In brief, a 44-year-old man was referred to our hospital presenting with fatigue and hyperglycemia. On admission, he was diagnosed as type 2 diabetes with HbA1c value of 11.5% and severe aGHD. Together with diet for diabetes, GHRT was commenced. His glycemic control was dramatically improved with a reduction of HbA1c value from 11.5% to 5.5% by GHRT for 3 months. HbA1c has been maintained around 5.5% for more than one year without any antidiabetic drugs. HOMA-IR was 1.76 on admission and decreased down to 1.04 one year later, indicating that his insulin resistance was apparently improved by the treatment.

Conclusion

GHRT brought a favorable effect on glycemic control to diabetic patients. Our results highlight the usefulness of GHRT in diabetic patients with aGHD.

(1) Rosenfalck AM et al., J Clin Endocrinol Metab 2000; 85:4173-81. (2) Bramnert M et al., J Clin Endocrinol Metab 2003; 88:1455-63. (3) Luger A et al., Diabetes Care 2012;35:57-62. (4) Yuen KC et al., Clin Endocrinol (Oxf) 2005;63:428-36. (5) Arafat AM et al., Diabetologia 2010;53:1304-13. (6) Abs R et al., Eur J Endocrinol 2012 Dec 4.

Nothing to Disclose: MK, IA, MA, HK, KO, MN, RT

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm