Abstract
Objectives Untreated acromegaly is a nature model for unveiling the diabetogenic effects of GH. CGMS can uncover more glucose profile of acromegaly. This study aimed to evaluate the insulin resistance (IR), β-cell function, and glycemic spectrum of patients with newly diagnosed acromegaly with normal glucose tolerance (NGT). Methods This study was conducted in Huashan Hospital from January 2015 to February 2019. Eight newly diagnosed acromegalic patients without history of diabetes and eight age- and gender-matched healthy subjects were enrolled. All participants underwent oral glucose tolerance test (OGTT) and 72 h continuous glucose monitoring (CGM). Parameters on β-cell function and IR were calculated. Mean blood glucose (MBG) in 24 hours was adopted for the evaluation of the glycemic level, and standard deviation of blood glucose (SDBG) and mean amplitude of glycemic excursion (MAGE) were used for glucose fluctuation. Results HbA1c in the acromegaly group was significantly higher than in the control. During OGTT, glucose peaked at 60 min in acromegaly and at 30 min in controls. After glucose load, the acromegaly group had significantly higher insulin levels than controls, especially in 120 min and 180 min. Both insulin sensitivity index and disposal index after glucose load of acromegaly were significantly lower than those of controls. Moreover, acromegalic subjects had significantly higher MBG than controls. Conclusions The newly diagnosed acromegalic patients with NGT were characterized by IR and impaired β-cell function after glucose load. CGM showed that MBG of NGT acromegaly patients was higher than that of normal people.
Highlights
Is caused by excessive secretion of the growth hormone (GH), resulting in increased production of insulinlike growth factor-1 (IGF-1), which is responsible for clinical manifestations and for the systemic complications associated with increased mortality [1]
Normal glucose tolerance (NGT) was defined as fasting blood glucose (FBG) below 6.1 mmol/L and 2-hour plasma blood glucose below 7.8 mmol/L according to the World Health Organization (WHO) criteria [17]
Our study demonstrated hyperinsulinemia and reduced insulin sensitivity (ISOGTT) of acromegalic patients with normal glucose tolerance (NGT) compared with healthy subjects
Summary
Is caused by excessive secretion of the growth hormone (GH), resulting in increased production of insulinlike growth factor-1 (IGF-1), which is responsible for clinical manifestations and for the systemic complications associated with increased mortality [1].e incidence of glucose intolerance in acromegaly is very common. A metaanalysis has showed that the all-cause mortality risk in patients with acromegaly was 1.72 (95% confidence interval: 0.62–1.83) [7]. Studies have shown that hyperglycemia is probably a risk factor for the poor prognosis of acromegaly independently of cardiovascular disease [8,9,10]. Pathologic increases in plasma growth hormone concentrations in acromegaly cause hyperinsulinemia and insulin resistance [11,12,13]. Some studies have described the glucose profile, beta-cell function, and insulin sensitivity in patients with acromegaly, most of them enrolled the GH patients under antidiabetic medicine which may interfere beta-cell function and insulin sensitivity analysis [14, 15]. We enrolled the newly diagnosed acromegalic patients without any intervention to the beta-cell function and insulin sensitivity evaluation
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