Higuchi Yuichi, Bando Hironori, Yamamoto Masaaki, Hirota Yushi, Ogawa Wataru, Fukuoka Hidenori
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe 650-0017, Japan.
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
JCEM Case Rep. 2025 Sep 25;3(11):luaf214. doi: 10.1210/jcemcr/luaf214. eCollection 2025 Nov.
Somapacitan, a once-weekly GH preparation used to treat GH deficiency, has effects on glucose tolerance similar to those of daily GH (somatropin) treatment. However, its effects on glycemic control in patients with type 1 diabetes mellitus (T1DM) remain unclear. A 50-year-old man with hypopituitarism and T1DM switched from somatropin to somapacitan at his request. Soon thereafter, he experienced frequent hypoglycemia, which led to an emergency department visit. Continuous glucose monitoring revealed weekly glucose fluctuations, which correlated with GH levels. Serum free fatty acids showed a parallel trend. These findings suggested that insulin dose adjustments throughout the week were necessary. Despite increasing the somapacitan dose, insulin titration was still required to stabilize glycemic variability. After treatment modifications, the number of hypoglycemic episodes significantly decreased, and his quality of life improved. This case highlights the need for close glucose monitoring and individualized insulin management when transitioning from daily to long-acting GH therapy in insulin-dependent patients. This report provides insights into the metabolic effects of GH fluctuations in T1DM and the potential impact of somapacitan on insulin sensitivity. Further studies are warranted to establish optimal GH dosing strategies for patients with diabetes undergoing GH replacement therapy.
索马帕西坦是一种用于治疗生长激素缺乏症的每周一次的生长激素制剂，其对葡萄糖耐量的影响与每日使用生长激素（生长激素释放激素）治疗相似。然而，其对1型糖尿病（T1DM）患者血糖控制的影响仍不明确。一名患有垂体功能减退症和T1DM的50岁男性应其要求从生长激素释放激素改用索马帕西坦。此后不久，他频繁发生低血糖，导致前往急诊科就诊。持续葡萄糖监测显示每周血糖波动，这与生长激素水平相关。血清游离脂肪酸呈平行趋势。这些发现表明，整周都需要调整胰岛素剂量。尽管增加了索马帕西坦剂量，但仍需要胰岛素滴定以稳定血糖变异性。经过治疗调整后，低血糖发作次数显著减少，他的生活质量得到改善。该病例突出了在胰岛素依赖型患者从每日生长激素治疗过渡到长效生长激素治疗时，密切监测血糖和个体化胰岛素管理的必要性。本报告深入探讨了T1DM中生长激素波动的代谢影响以及索马帕西坦对胰岛素敏感性的潜在影响。有必要进行进一步研究，以确定接受生长激素替代治疗的糖尿病患者的最佳生长激素给药策略。
