title: Glycometabolic control in acromegalic patients with diabetes: a study of the effects of different treatments for growth hormone excess and for hyperglycemia.
abstract: BACKGROUND
  Diabetes mellitus is frequently observed in patients with acromegaly. Current therapies for acromegaly may impact glucose regulation, influencing insulin sensitivity and secretion. The question whether these therapies modify control and progression of diabetes once present is still open.
  
  
  OBJECTIVE
  Aim of our study is to analyze glucose control in acromegalic patients with diabetes, evaluating the relation with treatments for GH excess and for diabetes.
  
  
  METHODS
  Seventy patients with acromegaly and diabetes were studied. Duration and treatments of acromegaly and diabetes were recorded, together with clinical and metabolic parameters.
  
  
  RESULTS
  Most patients (92.8%) were treated with somatostatin analogs (SSA), either alone or in combination with dopamine-agonists (20%) or pegvisomant (15.7%); 7.1% of patients had been treated by surgery alone. Metformin (65.7%), alone or in combination with other hypoglycemic drugs, was the most frequent treatment for diabetes, followed by insulin (21.5%). Only 15.7% were treated with diet alone. The whole cohort showed a very good control of diabetes and acromegaly. Median glycated hemoglobin was 6.4% (5.9-7). IGF-I was within normal range for age in most patients. No relation was observed between duration of acromegaly or diabetes and metabolic control. SSA had a negative effect on insulin secretion, but these effects did not influence glucose control. Finally, we observed a low prevalence of nephropathy (6%) and retinopathy (20%).
  
  
  CONCLUSIONS
  Our study shows that a good control of hyperglycemia can be obtained with success in the majority of acromegalic patients with diabetes, independently of the type of treatment for GH excess.
authors.affiliation: Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy.
authors.forename: V M
authors.initials: VM
authors.lastname: Cambuli
authors.forename: M
authors.initials: M
authors.lastname: Galdiero
authors.forename: M
authors.initials: M
authors.lastname: Mastinu
authors.forename: F
authors.initials: F
authors.lastname: Pigliaru
authors.forename: R S
authors.initials: RS
authors.lastname: Auriemma
authors.forename: A
authors.initials: A
authors.lastname: Ciresi
authors.forename: R
authors.initials: R
authors.lastname: Pivonello
authors.forename: M
authors.initials: M
authors.lastname: Amato
authors.forename: C
authors.initials: C
authors.lastname: Giordano
authors.forename: S
authors.initials: S
authors.lastname: Mariotti
authors.forename: A
authors.initials: A
authors.lastname: Colao
authors.forename: M G
authors.initials: MG
authors.lastname: Baroni
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000150:complications / Q000378:metabolism* / Q000628:therapy*; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000097:blood / Q000378:metabolism* / Q000628:therapy; D003920:Diabetes Mellitus / Q000097:blood / Q000378:metabolism* / Q000628:therapy*; D018491:Dopamine Agonists / Q000627:therapeutic use; D013507:Endocrine Surgical Procedures; D006442:Glycated Hemoglobin / Q000378:metabolism; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000378:metabolism / Q000628:therapy; D008875:Middle Aged; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D018491:Dopamine Agonists; D006442:Glycated Hemoglobin; D019382:Human Growth Hormone; D013004:Somatostatin; C517652:hemoglobin A1c protein, human