An examination of the effects of different doses of recombinant human growth hormone on children with growth hormone deficiency

Xue, Yongbiao; Gao, Yiqing; Wang, Shuqin; Wang, Pei

doi:10.3892/etm.2016.3091

Cited by 15 publications

(10 citation statements)

References 37 publications

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“…Fasting glucose is undoubtedly the parameter mostly used to evaluate glucose metabolism in almost all studies (21/24; 87.5%). In a recent study, Xue et al reported a significant increase in fasting glucose in 60 children during 6 months of GHT, although in half of the patients a high GH dose (0.1 U/kg) was used ( 72 ). Similar results have been shown by Chen et al in 60 children after 12 months of GHT, regardless of the GH dose used ( 68 ) and these data have been confirmed by four other studies ( 60 , 62 – 64 ).…”

Section: Resultsmentioning

confidence: 99%

Glucose Metabolism in Children With Growth Hormone Deficiency

Ciresi

2018

Front. Endocrinol.

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BackgroundThe growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis has a fundamental impact on glucose metabolism. Therefore, both untreated GH deficiency (GHD) and GH treatment (GHT) may be associated with some metabolic alterations, although the abnormalities of glucose metabolism have been investigated by relatively few studies as main outcomes.AimThe present review summarizes the available data on glucose metabolism in children with GHD, providing an overview of the current state of the art in order to better clarify the real metabolic impact of GHD and GHT.MethodsAmong all the existing studies, we evaluated all original studies that fulfilled our criteria for analysis reporting parameters of glucose metabolism as the primary or secondary objective.ResultsThe reported impact of GHD per se on glucose metabolism is quite homogeneous, with the majority of studies reporting no significant difference in metabolic parameters between GHD children and controls. Conversely, GHT proves to be more frequently associated with a subtle form of insulin resistance, while both fasting glucose and HbA1c levels remain almost always within the normal range.ConclusionThe different methods to study glucose metabolism, the heterogeneity of the populations evaluated, the different doses of GH used together with the variable duration of follow-up may be responsible for discrepancy in the results. Long-term longitudinal studies having glucose homeostasis as their primary outcome are still needed in order better to clarify the real metabolic impact of GHD and GHT in children.

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Section: Resultsmentioning

confidence: 99%

Glucose Metabolism in Children With Growth Hormone Deficiency

Ciresi

2018

Front. Endocrinol.

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“…Data from the main registries on children treated with rhGH (5,6) suggest that this therapy may accelerate the onset of type 2 diabetes mellitus in predisposed patients, with a prevalence of 0.36% of abnormal glucose metabolism and a six-fold increase in the incidence of type 2 diabetes. Several other studies have investigated the effects of rhGH therapy on glucose metabolism in children (17,18,19,20,21,22). Nevertheless, as highlighted in a recent systematic review (8), only in relatively few studies glucose metabolism abnormalities were the main outcome.…”

Section: Discussionmentioning

confidence: 99%

Glucose Metabolism Evaluated by Glycated Hemoglobin and Insulin Sensitivity Indices in Children Treated with Recombinant Human Growth Hormone

Pellegrin¹,

Michelon²,

Faleschini³

et al. 2019

Jcrpe

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Objective:To evaluate glucose metabolism and insulin sensitivity in children with idiopathic growth hormone (GH) deficiency, treated with recombinant human GH (rhGH), and to identify possible risk factors for the development of glucose abnormalities in this population.Methods:We retrospectively collected data from 101 patients (60 males, median age 10.4 years, 77 prepubertal), with confirmed GH deficiency, enrolled before starting rhGH and followed up during the first three years of treatment. Glucose metabolism was evaluated annually by oral glucose tolerance test (OGTT) and glycated hemoglobin A1c (HbA1c). OGTT was used to calculate insulin sensitivity (HOMA-S) and insulin resistance (HOMA-IR), defined as HOMA-IR >3.Results:RhGH was effective in improving growth and dosages significantly reduced after the first year of therapy. No patient developed diabetes mellitus. After one year of therapy, a significant increase in HbA1c (p=0.0042) and insulin levels (fasting p<0.0001, 60 min p=0.0018, 120 min p=0.0003) was observed, with a higher prevalence of IR (p<0.05). These indices did not alter further during the follow-up and were not related to GH dose or to family history of diabetes. A significant correlation was found only for IR indices and pubertal status, weight and age (p<0.05).Conclusion:In this retrospective study on a large GH deficient pediatric population, conventional use of replacement therapy resulted in an increase in HbA1c and IR after one year of therapy, regardless of rhGH dosage. These alterations did not worsen significantly in the following two years and were not associated with overt diabetes.

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“…DISCUSSION Data from the main registries on children treated with rhGH (5,6) suggest that this therapy may accelerate the onset of type 2 diabetes mellitus in predisposed patients, with a prevalence of 0.36% of abnormal glucose metabolism and a six-fold increase in the incidence of type 2 diabetes. Several other studies have investigated the effects of rhGH therapy on glucose metabolism in children (17)(18)(19)(20)(21)(22). Nevertheless, as highlighted in a recent systematic review (8), only in relatively few studies glucose metabolism abnormalities were the main outcome.…”

Section: Evaluation Of Glucose Metabolismmentioning

confidence: 99%

Glucose Metabolism Evaluated By Glycated Hemoglobin And Insulin Sensitivity Indexes In Children Treated With Recombinant Human Growth Hormone

Pellegrin¹,

Michelon²,

Faleschini³

et al. 2019

Jcrpe

View full text Add to dashboard Cite

Objective: To evaluate glucose metabolism and insulin sensitivity in children with idiopathic growth hormone (GH) deficiency treated with recombinant human GH (rhGH) and to identify possible risk factors for the development of glucose abnormalities in this population. Methods: We retrospectively collected data from 101 patients (60 males, median age 10.4 years, 77 prepubertal), with confirmed GH deficiency, enrolled before starting rhGH and followed up for the first three years of treatment. Glucose metabolism was evaluated every year by oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c). OGTT was used to calculate insulin sensitivity (HOMA-S) and insulin resistance (HOMA-IR), defined as HOMA-IR>3. Results: RhGH was effective in improving growth and its dosage was significantly reduced after the first year of therapy. No patient developed diabetes mellitus. After one year of therapy, a significant increase in HbA1c (p=0.0042) and insulin levels (fasting p<0.0001, 60 min p=0.0018, 120 min p=0.0003) was observed, with higher prevalence of insulin resistance (p<0.05 for HOMA-IR). These indexes did not alter further during the follow-up and were not related to GH doses or to familiarity for diabetes. A significant correlation was found only for insulin resistance indexes and pubertal status, weight and age (p<0.05). Conclusions:In this retrospective study on a large GH deficient pediatric population, conventional use of replacement therapy resulted in an increase in HbA1c and insulin resistance after one year of therapy, regardless of rhGH dosage. These alterations were transient and not associated with significant changes in glucose metabolism during the subsequent follow-up. What is already known on this topic?Growth hormone plays an anti-insulin effect. Children treated with recombinant human GH (rhGH) may develop abnormalities in glucose metabolism, and present a higher incidence of type-2 diabetes mellitus, particularly in subjects with predisposing conditions such as obesity or positive family history. What this study adds?In this study, conventional use of rhGH, in a large GH deficient pediatric population, resulted in increased HbA1c and worsened insulin sensitivity after one year of therapy, although, at the subsequent follow-up, these indexes had not deteriorated further and were not associated with significant changes in glucose metabolism. This therapy proved to be safe, even in subjects considered at risk for glucose metabolism alteration.

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An examination of the effects of different doses of recombinant human growth hormone on children with growth hormone deficiency

Cited by 15 publications

References 37 publications

Glucose Metabolism in Children With Growth Hormone Deficiency

Glucose Metabolism in Children With Growth Hormone Deficiency

Glucose Metabolism Evaluated by Glycated Hemoglobin and Insulin Sensitivity Indices in Children Treated with Recombinant Human Growth Hormone

Glucose Metabolism Evaluated By Glycated Hemoglobin And Insulin Sensitivity Indexes In Children Treated With Recombinant Human Growth Hormone

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