Cutfield W S, Wilton P, Bennmarker H, Albertsson-Wikland K, Chatelain P, Ranke M B, Price D A
Department of Paediatrics, University of Auckland, New Zealand.
Lancet. 2000 Feb 19;355(9204):610-3. doi: 10.1016/S0140-6736(99)04055-6.
Growth hormone (GH) contributes to insulin resistance, but whether children treated with GH are at increased risk of diabetes has not been established. We undertook a retrospective analysis of data from an international pharmacoepidemiological survey of children treated with GH to find out the incidence of impaired glucose tolerance and types 1 and 2 diabetes mellitus.
Reports to the survey of abnormal glucose metabolism were investigated and classified. The incidence and age-distribution of type 1 diabetes were compared with values from a model of reference data. The incidence of type 2 diabetes was compared with data from two reports of children not treated with GH.
85 (0.36%) of 23333 children were reported with abnormal glucose metabolism. After investigation, 43 had confirmed glucose disorders (11 with type 1 diabetes, 18 with type 2 diabetes, and 14 with impaired glucose tolerance). The incidence and age at diagnosis of type 1 diabetes in children treated with GH did not differ from expected values. The incidence of type 2 diabetes was 34.4 cases per 100000 years of GH treatment which was six-fold higher than reported in children not treated with GH. Type 2 diabetes did not resolve after GH therapy was stopped.
GH treatment did not affect the incidence of type 1 diabetes mellitus in any age group. We postulate that the higher than expected incidence of type 2 diabetes mellitus with GH treatment may be an acceleration of the disorder in predisposed individuals.
生长激素（GH）会导致胰岛素抵抗，但接受GH治疗的儿童患糖尿病的风险是否增加尚未明确。我们对一项关于接受GH治疗儿童的国际药物流行病学调查数据进行了回顾性分析，以了解糖耐量受损及1型和2型糖尿病的发病率。
对该调查中有关葡萄糖代谢异常的报告进行调查并分类。将1型糖尿病的发病率和年龄分布与参考数据模型中的值进行比较。将2型糖尿病的发病率与两份未接受GH治疗儿童报告中的数据进行比较。
在23333名儿童中，有85名（0.36%）报告存在葡萄糖代谢异常。经调查，43名确诊患有葡萄糖紊乱（11名患有1型糖尿病，18名患有2型糖尿病，14名患有糖耐量受损）。接受GH治疗儿童的1型糖尿病发病率和诊断年龄与预期值无差异。2型糖尿病的发病率为每100000年GH治疗中有34.4例，这比未接受GH治疗儿童报告中的发病率高六倍。停止GH治疗后，2型糖尿病并未缓解。
GH治疗对任何年龄组的1型糖尿病发病率均无影响。我们推测，接受GH治疗的2型糖尿病发病率高于预期，可能是易感个体中该疾病的加速发展。
