Zucchini Stefano, Iafusco Dario, Vannelli Silvia, Rabbone Ivana, Salzano Giuseppina, Pozzobon Gabriella, Maghnie Mohamad, Cherubini Valentino, Bizzarri Carla, Bonfanti Riccardo, D'Annunzio Giuseppe, Lenzi Lorenzo, Maggio Maria Cristina, Marigliano Marco, Scaramuzza Andrea, Tumini Stefano, Iughetti Lorenzo
Department of Pediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy.
Horm Res Paediatr. 2014;82(1):53-8. doi: 10.1159/000360856. Epub 2014 Jun 11.
BACKGROUND/AIM: Combined growth hormone (GH) and insulin therapy is rarely prescribed by pediatric endocrinologists. We investigated the attitude of Italian physicians to prescribing that therapy in the case of short stature and type-1 diabetes (T1DM).
A questionnaire was sent and if a patient was identified, data on growth and diabetes management were collected.
Data from 42 centers (84%) were obtained. Of these, 29 centers reported that the use of combined therapy was usually avoided. A total of 17 patients were treated in 13 centers (GH was started before T1DM onset in 9 patients and after the onset of T1DM in 8). Height SDS patterns during GH therapy in the 11 patients affected by GH deficiency ranged from -0.3 to +3.1 SDS. In the 8 diabetic patients in whom GH was added subsequently, mean insulin dose increased during the first 6 months of therapy from 0.7 ± 0.2 to 1.0 ± 0.2 U/kg (p = 0.004). HbA1c was unchanged during the first 6 months of combined therapy.
Most Italian physicians do not consider prescribing the combined GH-insulin therapy in diabetic children with growth problems. However, the results of the 17 patients identified would confirm that the combined therapy was feasible and only caused mild insulin resistance. GH therapy was effective in promoting growth in most patients and did not affect diabetes metabolic control.
背景/目的：儿科内分泌专家很少开具生长激素（GH）与胰岛素联合治疗的处方。我们调查了意大利医生对于为身材矮小且患有1型糖尿病（T1DM）的患者开具该联合治疗处方的态度。
发放了一份调查问卷，若识别出患者，则收集其生长及糖尿病管理方面的数据。
获得了42个中心（84%）的数据。其中，29个中心报告通常避免使用联合治疗。13个中心共治疗了17例患者（9例患者在T1DM发病前开始使用GH，8例在T1DM发病后开始使用）。11例生长激素缺乏患者在GH治疗期间的身高标准差积分（SDS）范围为-0.3至+3.1 SDS。在随后添加GH的8例糖尿病患者中，治疗的前6个月平均胰岛素剂量从0.7±0.2 U/kg增加至1.0±0.2 U/kg（p = 0.004）。联合治疗的前6个月糖化血红蛋白（HbA1c）没有变化。
大多数意大利医生不考虑为有生长问题的糖尿病儿童开具GH-胰岛素联合治疗的处方。然而，所识别出的17例患者的结果证实联合治疗是可行的，且仅引起轻度胰岛素抵抗。GH治疗对大多数患者促进生长有效，且不影响糖尿病的代谢控制。
