Sydlik Carmen, Weissenbacher Claudia, Roeb Julia, Pozza Susanne Bechtold-Dalla, Schmidt Heinrich
Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany.
Indian J Endocrinol Metab. 2019 Jan-Feb;23(1):14-21. doi: 10.4103/ijem.IJEM_91_18.
Although growth hormone (GH) therapy for children born small for gestational age (SGA) has been approved for many years, there are still concerns about increasing their risk for insulin resistance and diabetes mellitus type 2. Monitoring of glucose homeostasis is therefore generally recommended, but there is no consensus on either the methods or consequences.
The aim of our study was to analyze the oral Glucose Tolerance Tests (oGTTs) which were performed yearly from baseline to 4 years of GH therapy in a collective of 93 SGA children, who were prepubertal during the whole follow-up. We looked for correlations with auxological and laboratory data as well as predictive baseline results for glucose homeostasis during further treatment.
While glucose levels remained constant, insulin secretion increased from baseline to the first year of GH therapy. Insulin sensitivity index (ISI) showed no significant change afterwards; HOMA1, HOMA2, and QUICKI stabilized after the second year. For all indices mean values never reached pathological levels and no cases of diabetes mellitus were induced. Higher gestational age, lower birth length, and older age at start of GH therapy were associated with lower insulin sensitivity. No predictive factors for later insulin resistance could be found.
As expected, in GH-treated prepubertal SGA children insulin resistance was induced, but not to pathological levels. No special risk factors for disturbed glucose homeostasis could be identified. Based on our opinion, performing oGTTs in GH-treated SGA children at baseline and in puberty should remain mandatory, but the current study recommendations regarding further surveillance of glucose homeostasis are questionable.
尽管对小于胎龄儿（SGA）儿童使用生长激素（GH）治疗已获批多年，但人们仍担心这会增加他们患胰岛素抵抗和2型糖尿病的风险。因此，通常建议监测葡萄糖稳态，但在监测方法和结果方面尚无共识。
我们研究的目的是分析93例SGA儿童从基线到接受GH治疗4年期间每年进行的口服葡萄糖耐量试验（oGTT），这些儿童在整个随访期间均未进入青春期。我们寻找其与体格学和实验室数据的相关性，以及进一步治疗期间葡萄糖稳态的预测性基线结果。
虽然血糖水平保持恒定，但从基线到GH治疗的第一年胰岛素分泌增加。此后胰岛素敏感性指数（ISI）无显著变化；HOMA1、HOMA2和QUICKI在第二年之后趋于稳定。所有指标的平均值均未达到病理水平，也未诱发糖尿病病例。较高的胎龄、较短的出生身长以及开始GH治疗时的年龄较大与较低的胰岛素敏感性相关。未发现后期胰岛素抵抗的预测因素。
正如预期的那样，接受GH治疗的青春期前SGA儿童会出现胰岛素抵抗，但未达到病理水平。未发现葡萄糖稳态紊乱的特殊危险因素。我们认为，对接受GH治疗的SGA儿童在基线和青春期进行oGTT仍应是强制性的，但目前关于进一步监测葡萄糖稳态的研究建议值得怀疑。
