title: The effect of growth hormone (GH) replacement on blood glucose homeostasis in adult nondiabetic patients with GH deficiency: real-life data from the NordiNet®International Outcome Study.
abstract: OBJECTIVE
  To assess the effect of 4 years' growth hormone (GH) replacement on glucose homeostasis and evaluate factors affecting glycosylated haemoglobin (HbA1c) in adults with growth hormone deficiency (GHD).
  
  
  METHODS
  NordiNet®International Outcome Study, a noninterventional study, monitors long-term effectiveness and safety of GH replacement [Norditropin®(somatropin), Novo Nordisk A/S] in real-life clinical practice.
  
  
  METHODS
  Nondiabetic patients (n = 245) with adult-onset GHD (age ≥20 years at GH start), ≥4 years' GH replacement and HbA1cvalues at baseline and 4 years were included in the analysis.
  
  
  METHODS
  Changes from baseline (∆) to 4 years in HbA1c, fasting plasma glucose (FPG), IGF-I, lipids (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglycerides), waist circumference, glycaemic (HbA1c<5·7%; HbA1c, 5·7-6·5%; HbA1c, ≥6·5%) and metabolic health status were evaluated. Effects of baseline HbA1c, gender, baseline age, average GH dose and baseline body mass index (BMI) on ΔHbA1cwere investigated. The models were adjusted for concomitant medication use.
  
  
  RESULTS
  Mean (standard deviation) baseline HbA1cwas 5·13 (0·65)% and remained at the same level at 4 years. Age at treatment start (P = 0·0094) and BMI (P = 0·0008) had a significant impact on ∆HbA1c. At 4 years, 85% of patients with HbA1c<5·7% (normal levels) at baseline and 55% of patients with HbA1c5·7-6·5% (impaired glucose tolerance) at baseline remained in the same glycaemic health category. Nineteen patients improved from impaired glucose tolerance to normal HbA1c. Seven patients developed diabetes.
  
  
  CONCLUSIONS
  These data demonstrate that 4 years' GH replacement therapy did not adversely affect glucose homeostasis in the majority of adults with GHD.
authors.affiliation: Department of Endocrinology and Metabolism, Medical Clinic, University of Mainz, Mainz, Germany.
authors.forename: Matthias M
authors.initials: MM
authors.lastname: Weber
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Beverly M K
authors.initials: BM
authors.lastname: Biller
authors.affiliation: Epidemiology, Novo Nordisk A/S, Søborg, Denmark.
authors.forename: Birgitte Tønnes
authors.initials: BT
authors.lastname: Pedersen
authors.affiliation: Novo Nordisk Health Care AG, Zurich, Switzerland.
authors.forename: Effie
authors.initials: E
authors.lastname: Pournara
authors.affiliation: Department of Endocrinology and Diabetes, MEA, Aarhus University Hospital, NBG, Aarhus, Denmark.
authors.forename: Jens Sandahl
authors.initials: JS
authors.lastname: Christiansen
authors.affiliation: Department of Endocrinology, Metabolism and Diabetology, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Höybye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D003920:Diabetes Mellitus; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D013006:Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use; D006706:Homeostasis / Q000187:drug effects*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D013006:Growth Hormone