Prevalence of diabetes mellitus in 6050 hypopituitary patients with adult-onset GH deficiency before GH replacement: a KIMS analysis

• Published in: European journal of endocrinology Vol. 168; no. 3; pp. 297 - 305
• Main Authors: Abs, Roger, Mattsson, Anders F, Thunander, Maria, Verhelst, Johan, Góth, Miklós I, Wilton, Patrick, Kołtowska-Häggström, Maria, Luger, Anton
• Format: Journal Article
• Language: English
• Published: Bristol BioScientifica 01.03.2013
• Subjects: Adult; Age of Onset; Aged; Biological and medical sciences; Body Mass Index; Clinical Medicine; Clinical Study; Cohort Studies; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - etiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinology and Diabetes; Endocrinopathies; Endokrinologi och diabetes; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Europe - epidemiology; Female; Fundamental and applied biological sciences. Psychology; General aspects; Glycated Hemoglobin A - analysis; Human Growth Hormone - deficiency; Humans; Hypopituitarism - blood; Hypopituitarism - complications; Hypopituitarism - physiopathology; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Overweight - complications; Poisson Distribution; Prevalence; Public health. Hygiene; Public health. Hygiene-occupational medicine; Sex Factors; United States - epidemiology; Vertebrates: endocrinology; Young Adult; Endocrinopathy; Human; Replacement therapy; Prevalence; Diabetes mellitus; Deficiency; Patient; Epidemiology; Somatotropin; Adenohypophyseal hormone; Hypophyseal insufficiency; Pituitary diseases; Adult; Endocrinology
• DOI: 10.1530/EJE-12-0807
• ISSN: 0804-4643; 1479-683X

ObjectiveGH deficiency (GHD) in adults is characterized by a tendency toward obesity and an adverse body composition with visceral fat deposit and may thus predispose to the development of type 2 diabetes mellitus. The aim of this study was to assess the observed prevalence proportion (PP) and observed PP over expected PP ratio (standardized prevalence proportion ratio, SPR) of diabetes according to International Diabetes Federation criteria in a large cohort of GH-untreated adult-onset GHD patients.Design and methodsAssociations between baseline variables and diabetes prevalence in 6050 GHD patients from KIMS (Pfizer International Metabolic Database) were studied and robust Poisson-regression analyses were performed. Comparisons between baseline status and HbA1c categories in the nondiabetic patients were done with covariance analysis. P values <0.05 were considered statistically significant.ResultsPP was 9.3% compared with the expected 8.2%. SPR was 1.13 (95% confidence intervals (95% CIs), 1.04–1.23), which was significantly increased in females (1.23; 95% CI, 1.09–1.38%) but not in males (SPR 1.04; 95% CI, 0.92–1.17%). PP increased significantly by age, familial diabetes, country selection, BMI, waist circumference, number of pituitary deficiencies, and GHD etiology. SPR decreased significantly by age and increased significantly by BMI, waist circumference, and IGF1 SDS. Multiple regression model showed that the most important impact on SPR was from age and BMI. HbA1c values of 6.0–6.5% were found in 9.5% of nondiabetic patients and were associated with higher BMI and waist circumference.ConclusionsGHD is associated with an increased prevalence of diabetes, largely to be explained by the adverse body composition. These data urge toward early initiation of lifestyle modification measures.