The effect of growth hormone (GH) replacement therapy in adult patients with type 1 diabetes mellitus and GH deficiency

TY - JOUR

T1 - The effect of growth hormone (GH) replacement therapy in adult patients with type 1 diabetes mellitus and GH deficiency

AU - Christ, E R

AU - Simpson, H L

AU - Breen, L

AU - Sonksen, P H

AU - Russell-Jones, D L

AU - Kohner, E M

PY - 2003/3/1

Y1 - 2003/3/1

N2 - OBJECTIVES Specific problems in patients with insulin-dependent diabetes mellitus (IDDM) and GH deficiency are hypoglycaemic attacks, increased insulin sensitivity and loss of energy. These problems may be related to GH deficiency. PATIENTS GH replacement was initiated in five patients with type 1 diabetes mellitus and GH deficiency for 6 months [four males and one female, mean age 41.6 +/- 3.8 years, mean +/- standard error of the mean (SEM); body mass index (BMI) 22.3 +/- 1.2 kg/m(2) ]. METHODS Body composition (bioimpedance), metabolic control [haemoglobin A1(C) (HbA1(C) )], insulin requirement and frequency of hypoglycaemia were measured, and quality of life was assessed using validated questionnaires. Monthly eye photographs were taken. RESULTS IGF-I concentrations were below the age-adjusted range at baseline and increased significantly following GH replacement therapy [analysis of variance (anova), P <0.05]. Diabetes control as assessed by HbA1(C) remained stable (8.2 +/- 0.2 vs . 8.0 +/- 0.4), but needed a 1.75-fold increase in insulin dose/day. Lean body mass tended to increase (P = 0.07) and body fat mass decreased significantly (P > 0.01). Number of severe hypoglycaemic (<3 mmol/l) attacks decreased significantly (P <0.04) and quality of life assessed by validated questionnaires improved significantly in all patients [Psychological and General Well-Being Schedule (PGWBS), P <0.04; Nottingham Health Profile (NHP), P <0.05]. Monthly eye photographs revealed no changes in the retina in any patients. CONCLUSION GH replacement therapy has a beneficial effect at the dose used. It restores body composition and decreases frequency and severity of hypoglycaemic episodes, thus improving quality of life. Long-term trials are needed to determine the safety of GH replacement therapy in these patients.

AB - OBJECTIVES Specific problems in patients with insulin-dependent diabetes mellitus (IDDM) and GH deficiency are hypoglycaemic attacks, increased insulin sensitivity and loss of energy. These problems may be related to GH deficiency. PATIENTS GH replacement was initiated in five patients with type 1 diabetes mellitus and GH deficiency for 6 months [four males and one female, mean age 41.6 +/- 3.8 years, mean +/- standard error of the mean (SEM); body mass index (BMI) 22.3 +/- 1.2 kg/m(2) ]. METHODS Body composition (bioimpedance), metabolic control [haemoglobin A1(C) (HbA1(C) )], insulin requirement and frequency of hypoglycaemia were measured, and quality of life was assessed using validated questionnaires. Monthly eye photographs were taken. RESULTS IGF-I concentrations were below the age-adjusted range at baseline and increased significantly following GH replacement therapy [analysis of variance (anova), P <0.05]. Diabetes control as assessed by HbA1(C) remained stable (8.2 +/- 0.2 vs . 8.0 +/- 0.4), but needed a 1.75-fold increase in insulin dose/day. Lean body mass tended to increase (P = 0.07) and body fat mass decreased significantly (P > 0.01). Number of severe hypoglycaemic (<3 mmol/l) attacks decreased significantly (P <0.04) and quality of life assessed by validated questionnaires improved significantly in all patients [Psychological and General Well-Being Schedule (PGWBS), P <0.04; Nottingham Health Profile (NHP), P <0.05]. Monthly eye photographs revealed no changes in the retina in any patients. CONCLUSION GH replacement therapy has a beneficial effect at the dose used. It restores body composition and decreases frequency and severity of hypoglycaemic episodes, thus improving quality of life. Long-term trials are needed to determine the safety of GH replacement therapy in these patients.

UR - http://www.scopus.com/inward/record.url?scp=0037335035&partnerID=8YFLogxK

U2 - 10.1046/j.1365-2265.2003.01714.x

DO - 10.1046/j.1365-2265.2003.01714.x

M3 - Article

SN - 1365-2265

VL - 58

SP - 309

EP - 315

JO - Clinical endocrinology

JF - Clinical endocrinology

IS - 3

ER -