TY - JOUR
T1 - Glucose homeostasis in acromegaly
T2 - Effects of long-acting somatostatin analogues treatment
AU - Baldelli, Roberto
AU - Battista, Claudia
AU - Leonetti, Frida
AU - Ghiggi, Maria Rosaria
AU - Ribaudo, Maria Cristina
AU - Paoloni, Antonella
AU - D'Amico, Eugenio
AU - Ferretti, Elisabetta
AU - Baratta, Roberto
AU - Liuzzi, Antonio
AU - Trischitta, Vincenzo
AU - Tamburrano, Guido
PY - 2003/10/1
Y1 - 2003/10/1
N2 - OBJECTIVE: Acromegaly is a syndrome with a high risk of impaired glucose tolerance (IGT) and diabetes mellitus (DM). Somatostatin analogues, which are used for medical treatment of acromegaly, may exert different hormonal effects on glucose homeostasis. Twenty-four active acromegalic patients were studied in order to determine the long-term effects of octreotide-LAR and SR-lanreotide on insulin sensitivity and carbohydrate metabolism. DESIGN: Prospective study. PATIENTS: We studied 24 patients with active acromegaly, 11 males and 13 females, aged 50.7 ± 12.7 years, body mass index (BMI) 30.1 ± 4.8 (kg/m2). MEASUREMENTS: All patients underwent an oral glucose tolerance test (OGTT) and 12 also had an euglycaemic hyperinsulinaemic clamp. All patients were evaluated at baseline and after 6 months of somatostatin analogues therapy. RESULTS: Acromegalic patients showed low M-values in respect to the control group at baseline (P <0.05), followed by a significant improvement after 6 months of therapy (P <0.005 vs. baseline). Serum glucose levels at 120 min during OGTT worsened (P <0.05) during somatostatin analogs therapy in patients with normal glucose tolerance, but not in those with impaired glucose tolerance or diabetes mellitus. This was associated with a reduced (P <0.05) and 30 min delayed insulin secretion during OGTT. Also, HbA1c significantly deteriorated in all subjects after treatment (4.7 ± 0.6% and 5.1 ± 0.5%, basal and after six months, respectively, P <0.005). CONCLUSION: In acromegalic patients, somatostatin analogues treatment reduces insulin resistance, and also impairs insulin secretion. This may suggest that the use of oral secretagogue hypoglycaemic agents and/or insulin therapy should be considered rather than insulin sensitizers, as the treatment of choice in acromegalic patients who develop frank hyperglycaemia during somatostatin analogues therapy.
AB - OBJECTIVE: Acromegaly is a syndrome with a high risk of impaired glucose tolerance (IGT) and diabetes mellitus (DM). Somatostatin analogues, which are used for medical treatment of acromegaly, may exert different hormonal effects on glucose homeostasis. Twenty-four active acromegalic patients were studied in order to determine the long-term effects of octreotide-LAR and SR-lanreotide on insulin sensitivity and carbohydrate metabolism. DESIGN: Prospective study. PATIENTS: We studied 24 patients with active acromegaly, 11 males and 13 females, aged 50.7 ± 12.7 years, body mass index (BMI) 30.1 ± 4.8 (kg/m2). MEASUREMENTS: All patients underwent an oral glucose tolerance test (OGTT) and 12 also had an euglycaemic hyperinsulinaemic clamp. All patients were evaluated at baseline and after 6 months of somatostatin analogues therapy. RESULTS: Acromegalic patients showed low M-values in respect to the control group at baseline (P <0.05), followed by a significant improvement after 6 months of therapy (P <0.005 vs. baseline). Serum glucose levels at 120 min during OGTT worsened (P <0.05) during somatostatin analogs therapy in patients with normal glucose tolerance, but not in those with impaired glucose tolerance or diabetes mellitus. This was associated with a reduced (P <0.05) and 30 min delayed insulin secretion during OGTT. Also, HbA1c significantly deteriorated in all subjects after treatment (4.7 ± 0.6% and 5.1 ± 0.5%, basal and after six months, respectively, P <0.005). CONCLUSION: In acromegalic patients, somatostatin analogues treatment reduces insulin resistance, and also impairs insulin secretion. This may suggest that the use of oral secretagogue hypoglycaemic agents and/or insulin therapy should be considered rather than insulin sensitizers, as the treatment of choice in acromegalic patients who develop frank hyperglycaemia during somatostatin analogues therapy.
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U2 - 10.1046/j.1365-2265.2003.01876.x
DO - 10.1046/j.1365-2265.2003.01876.x
M3 - Article
C2 - 14510913
AN - SCOPUS:10744228519
VL - 59
SP - 492
EP - 499
JO - Clinical Endocrinology
JF - Clinical Endocrinology
SN - 0300-0664
IS - 4
ER -