title: Combined therapy with insulin and growth hormone in 17 patients with type-1 diabetes and growth disorders.
abstract: OBJECTIVE
  Combined growth hormone (GH) and insulin therapy is rarely prescribed by pediatric endocrinologists. We investigated the attitude of Italian physicians to prescribing that therapy in the case of short stature and type-1 diabetes (T1DM).
  
  
  METHODS
  A questionnaire was sent and if a patient was identified, data on growth and diabetes management were collected.
  
  
  RESULTS
  Data from 42 centers (84%) were obtained. Of these, 29 centers reported that the use of combined therapy was usually avoided. A total of 17 patients were treated in 13 centers (GH was started before T1DM onset in 9 patients and after the onset of T1DM in 8). Height SDS patterns during GH therapy in the 11 patients affected by GH deficiency ranged from -0.3 to +3.1 SDS. In the 8 diabetic patients in whom GH was added subsequently, mean insulin dose increased during the first 6 months of therapy from 0.7 ± 0.2 to 1.0 ± 0.2 U/kg (p = 0.004). HbA1c was unchanged during the first 6 months of combined therapy.
  
  
  CONCLUSIONS
  Most Italian physicians do not consider prescribing the combined GH-insulin therapy in diabetic children with growth problems. However, the results of the 17 patients identified would confirm that the combined therapy was feasible and only caused mild insulin resistance. GH therapy was effective in promoting growth in most patients and did not affect diabetes metabolic control.
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zucchini
authors.forename: Dario
authors.initials: D
authors.lastname: Iafusco
authors.forename: Silvia
authors.initials: S
authors.lastname: Vannelli
authors.forename: Ivana
authors.initials: I
authors.lastname: Rabbone
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Salzano
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pozzobon
authors.forename: Mohamad
authors.initials: M
authors.lastname: Maghnie
authors.forename: Valentino
authors.initials: V
authors.lastname: Cherubini
authors.forename: Carla
authors.initials: C
authors.lastname: Bizzarri
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bonfanti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Annunzio
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lenzi
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Maggio
authors.forename: Marco
authors.initials: M
authors.lastname: Marigliano
authors.forename: Andrea
authors.initials: A
authors.lastname: Scaramuzza
authors.forename: Stefano
authors.initials: S
authors.lastname: Tumini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Iughetti
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004393:Dwarfism, Pituitary / Q000188:drug therapy*; D005260:Female; D006130:Growth Disorders / Q000150:complications / Q000188:drug therapy; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007333:Insulin Resistance; D008297:Male; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D019382:Human Growth Hormone