Diabetes and Metabolism Research Unit, Vall D'Hebron Research Institute and CIBERDEM (ISCIII), Universidad Autónoma de Barcelona, Barcelona, Spain.
Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau and Sant Pau-Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
Pituitary. 2021 Apr;24(2):146-158. doi: 10.1007/s11102-020-01092-6. Epub 2020 Oct 21.
This review is aimed at examining whether the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is higher in Caucasian, adult, treatment-naïve patients with acromegaly (ACRO) than in the reference population independently of diabetes presence and to evaluate the impact of treatment [surgery and somatostatin analogues (SSAs)] on its assessment.
We systematically reviewed in PubMed and Web of Science from July 1985 to December 2019, registered with the code number CRD42020148737. The inclusion criteria comprised studies conducted in Caucasian adult treatment-naïve patients with active ACRO in whom HOMA-IR or basal insulin and glucose were reported. Three reviewers screened eligible publications, extracted the outcomes, and assessed the risk of biases.
Of 118 originally selected studies, 15 met the inclusion criteria. HOMA-IR was higher in ACRO than the reference population, with mean difference and (95% confidence intervals) of 2.04 (0.65-3.44), even in ACRO patients without diabetes, 1.89 (1.06-2.73). HOMA-IR significantly decreased after treatment with either surgery or SSAs - 2.53 (- 3.24- - 1.81) and - 2.30 (- 3.05- - 1.56); respectively. However, the reduction of HOMA-IR due to SSAs did not improve basal glucose.
HOMA-IR in treatment-naïve ACRO patients is higher than in the reference population, even in patients without diabetes. This finding, confirms that insulin resistance is an early event in ACRO. Our results also suggest that HOMA-IR is not an adequate tool for assessing insulin resistance in those patients treated with SSAs.
本综述旨在检查初治、白种人、成年肢端肥大症（ACRO）患者的胰岛素抵抗稳态模型评估（HOMA-IR）是否高于参考人群，无论是否存在糖尿病，并评估治疗[手术和生长抑素类似物（SSAs）]对其评估的影响。
我们在 PubMed 和 Web of Science 上系统检索了 1985 年 7 月至 2019 年 12 月的文献，注册号为 CRD42020148737。纳入标准包括：在白种人初治、患有活动性 ACRO 的成年患者中进行的研究，其中报告了 HOMA-IR 或基础胰岛素和血糖。三名审查员筛选了合格的出版物，提取了结果，并评估了偏倚风险。
在最初选择的 118 项研究中，有 15 项符合纳入标准。ACRO 患者的 HOMA-IR 高于参考人群，平均差异和（95%置信区间）为 2.04（0.65-3.44），即使在无糖尿病的 ACRO 患者中也为 1.89（1.06-2.73）。接受手术或 SSAs 治疗后，HOMA-IR 显著下降-2.53（-3.24- -1.81）和-2.30（-3.05- -1.56）；分别。然而，SSAs 降低 HOMA-IR 并不能改善基础血糖。
初治 ACRO 患者的 HOMA-IR 高于参考人群，即使在无糖尿病的患者中也是如此。这一发现证实了胰岛素抵抗是 ACRO 的早期事件。我们的结果还表明，HOMA-IR 不是评估那些接受 SSAs 治疗的患者胰岛素抵抗的合适工具。
