Glycometabolic control in Acromegalic patients with Diabetes: a study of the effects of different treatments for GH excess and for hyperglycaemia.

Background. Diabetes mellitus (DM) 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. Aim. Aim of our study is to analyse 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 DM were recorded, together with clinical and metabolic parameters. Results. Most patients (92.8%) were treated with somatostatin analogs (SSAs), either alone or in combination with dopamine-agonists (20%) or pegvisomant (15.7%). 7.1% patients had been treated by surgery alone. Metformin (65.7%), alone or in combination with other hypoglycaemic 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 A1c (HbA1c) was 6.4% (5.9-7). IGF-1 was within normal range for age in most patients. No relation was observed between duration of acromegaly or diabetes and metabolic control. SSAs 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 from the type of treatment for GH excess.