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Metabolic Syndrome Increases Diabetes Risk in Patients With Adult-Onset Growth hormone Deficiency: Presented at ECE

By Chris Berrie

BERLIN -- May 9, 2008 -- Pre-existing metabolic syndrome is a significant and strong predictor of diabetes during growth hormone treatment among patients with adult-onset growth hormone deficiency (GHD), and this risk increases with increasing body mass index (BMI).

These findings, from a surveillance data analysis, were presented here on May 5 at the 10th European Congress of Endocrinology (ECE).

Coinvestigator Andrea Attanasio, MD, Consultant, Eli Lilly and Company, Cascina del Rosone, Agliano Terme, Italy, presented the data on behalf of the Hypopituitary Control and Complication Study (HypoCCS) International Advisory Board.

Patients with adult-onset GHD show features of metabolic syndrome, including abdominal obesity, dyslipidaemia, and insulin resistance, which are themselves conditions associated with increased risk of diabetes.

Therefore, the HypoCCS researchers conducted their study to investigate the prevalence and effects of metabolic syndrome in patients with adult-onset GHD undergoing growth hormone replacement, with respect to determinants for development of diabetes.

The patients with adult-onset GHD were selected from the global observational HypoCCS database. "These databases are very valuable because, beyond the mechanistic models of control studies, they really tell you what is the level of care in clinical practice for these patients," Dr. Attanasio indicated.

The researchers identified 712 patients who received 2 or more years of growth hormone treatment and on whom they had complete information on criteria for the metabolic syndrome. These patients were assessed in relation to metabolic syndrome and 2-year incidence of diabetes according to baseline BMI.

Metabolic syndrome was defined as 3 or more criteria in the National Cholesterol Education Programme, based on presence of central obesity and levels of triglycerides, high-density lipoprotein cholesterol, blood pressure, and fasting plasma glucose.

Diabetes prevalence was based on any case of diabetes and/or diabetes treatment reported at baseline or reported de novo while receiving growth hormone-replacement therapy.

At baseline, the overall occurrence of metabolic syndrome was 43.0%, which was not changed significantly after 2 years of growth hormone treatment (44.2%).

However, there was a significant linear increase in baseline prevalence of metabolic syndrome across the BMI categories (age- and gender-adjusted; P < .01), from 11.0% for BMI <25 kg/m² to 73.9% for BMI >35 kg/m².

When also adjusted for BMI, for patients without metabolic syndrome at baseline (n = 406) and with baseline metabolic syndrome (n = 306), there was a significant increase not only in diabetes prevalence at 0 to 2 years (P < .001), but more specifically, in the incidence of de novo diabetes (0.6% vs 11.2%, respectively; P < .001). The increase in prevalence of metabolic syndrome from 0 to 2 years in patients with BMI of 30 kg/m² or higher while receiving growth hormone treatment did not reach significance (P = .133).

Dr. Attanasio concluded, "Those who have the metabolic syndrome have a higher risk to develop diabetes under growth hormone treatment, independently of BMI."

"Although BMI is a very strong predictor of developing type 2 diabetes in normal populations, the metabolic syndrome is an even stronger predictor in these patients under growth hormone treatment," he added.

Therefore, regardless of BMI, patients with adult-onset GHD accompanied by metabolic syndrome require close surveillance during growth hormone treatment as they are at higher risk of developing diabetes.

Dr. Attanasio's study was conducted with researchers at Lilly Research Laboratories, as well as colleagues in France, Australia, United States, and Sweden.

[Presentation title: New Occurrence of Diabetes Mellitus in Patients With Adult Onset GH Deficiency (GHD) on GH Therapy Is Dependent on the Presence of Metabolic Syndrome at Baseline: Data From the Hypopituitary Control and Complication Study (HypoCCS). Abstract P369]

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