Moderate deterioration in glucose tolerance during high-dose growth hormone therapy in glucocorticoid-treated patients with juvenile idiopathic arthritis.
OBJECTIVE
To describe glucose metabolism changes during growth hormone (GH) treatment in juvenile idiopathic arthritis (JIA).


METHODS
Observational study in 58 children on glucocorticoid therapy (GC) for JIA, of whom 28 received late GH therapy (7.3 +/- 3.4 years into GC), 15 early GH therapy (1.2 +/- 0.1 years into GC), and 15 no GH therapy. The GH dose was 0.46 mg/kg/week. Oral glucose tolerance testing with insulin and glycosylated hemoglobin assays were performed yearly. Nonparametric tests were used to compare groups after 3 years and regression analyses to estimate factors predicting glucose AUC and HOMA-IR at baseline and after 3 years.


RESULTS
GH combined with GC was associated with an increase in mean fasting insulinemia. Late GH therapy patients exhibited significant increases over time in mean fasting glycemia (p = 0.01), mean 2-hour postglucose load glycemia (p < 0.05), mean AUC for glucose (p < 0.05), and mean HOMA-IR (p < 0.05). Impaired glucose tolerance was found in 16/43 GH-treated patients (37%) and transient diabetes in 2 (5%) patients.


CONCLUSIONS
GH treatment in JIA children decreased insulin sensitivity but had only modest effects on glucose tolerance. Close monitoring by oral glucose tolerance testing is crucial before and during GH treatment, particularly during puberty and relapses.
Bismuth
Elise
E
Department of Pediatric Endocrinology, Robert Debré Teaching Hospital, Paris, France. elise.bismuth@rdb.aphp.fr
Chevenne
Didier
D
Czernichow
Paul
P
Simon
Dominique
D
D000293:Adolescent; D019540:Area Under Curve; D001171:Arthritis, Juvenile / Q000378:metabolism* / Q000628:therapy*; D001786:Blood Glucose / Q000378:metabolism*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D018149:Glucose Intolerance / Q000139:chemically induced* / Q000378:metabolism; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D012044:Regression Analysis
D001786:Blood Glucose; D005938:Glucocorticoids; D006442:Glycated Hemoglobin; D019382:Human Growth Hormone; D007328:Insulin