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Prevalence of diabetes mellitus in patients withacromegaly

机译：肢端肥大症患者的糖尿病患病率

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Early carbohydrate metabolism disorders (ECMDs) and diabetes mellitus (DM) arefrequently associated with acromegaly. We aimed to assess the prevalence of ECMDs inpatients with acromegaly and to compare the results with those in adults withoutacromegaly using two population-based epidemiologic surveys. We evaluated 97 patientswith acromegaly in several phases of their disease (mean age, 56 years and estimatedduration of acromegaly, 12.5 years). An oral glucose tolerance test was done in thosenot yet diagnosed with DM to reveal asymptomatic DM or ECMDs (impaired glucosetolerance+impaired fasting glucose). Comparisons were made between patients withacromegaly and participants from the general adult population( n =435) and an adult population with multiple type 2 diabetesrisk factors ( n =314), matched for gender, age and BMI. DM wasdiagnosed in 51 patients with acromegaly (52.5%) and 14.3% of the general population( P <0.001). The prevalence of ECMDs was also higher in patientswith acromegaly than in the general population and in the high-risk group; only 22%of patients with acromegaly were normoglycaemic. The prevalence of newly diagnosedECMDs or DM was 1.3–1.5 times higher in patients with acromegaly compared withthe high-risk group. Patients with acromegaly having ECMDs or DM were older, moreobese and had longer disease duration and higher IGF1 levels( Z -score). Logistic regression showed that the severity of glucosederangement was predicted by age, BMI and IGF1 levels. In patients with acromegaly,the prevalence of DM and ECMDs considerably exceeds that of the general populationand of a high-risk group, and development of DM depends on age, BMI and IGF1levels. Keywords: acromegaly, glucose, diabetes, IGF1, epidemiologyIntroductionDisturbances of glucose metabolism are frequently observed in patients with acromegaly.In one of the first papers to be published on this topic, abnormal glucose tolerance wasfound in over 60% of patients with acromegaly (1). The glucose anomalies in these patients are now known to includediabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fasting glucose(IFG) and have been discussed extensively in a review by Colao et al .(2). Looking more specifically at earlycarbohydrate metabolism disorders (ECMDs) – defined as IFG, IGT or theircombination – its prevalence in patients with acromegaly has been shown to varybetween 16 and 46% (3, 4, 5). Whilemost epidemiological studies have shown the prevalence of ECMDs to be higher than thatof overt diabetes (2, 5, 6, 7),not all studies report the same prevalence (3,8). The development of ECMDs and/or progression to diabetes in patients withacromegaly may depend on several factors, such as age and gender (5), the levels of growth hormone (GH) (9), as well as the duration of acromegaly and duration of exposureto elevated GH levels (9, 10). However,other authors have found no differences in GH levels and insulin-like growth factor 1(IGF1) levels or disease duration between those with glucose disturbances and those whowere normoglycaemic (5, 6, 10,11). A further possible factor involved in the early development of diabetesis a positive family history of DM (5,12). A final factor that may also influence the development of glucosedisturbances is the specific treatment for acromegaly. Somatostatin analogues mayinfluence glucose metabolism both by lowering insulin secretion and by lowering GH andIGF1 levels (13, 14).The aim of this study was to assess the prevalence of ECMDs and DM in patients withacromegaly undergoing treatment at a large tertiary referral centre in Moscow (15) and to compare the results with theprevalence of such glucose disturbances in adults without acromegaly using twopopulation-based surveys (16, 17). Wealso analysed the factors contributing to the development of hyperglycaemia.Subjects and methodsPatientsA total of 97 patients with acromegaly undergoing treatment or long-term follow-up atthe outpatient clinic of the Moscow Regional Clinical Research State Instituteunderwent an extensive evaluation, which included measurement of height, weight andblood pressure. Those patients who had not previously been diagnosed with DMunderwent an oral glucose tolerance test (OGTT). In the fasting state, and 30, 60, 90and 120?min after oral administration of 75?g glucose, blood was drawnfor the simultaneous measurement of plasma levels of GH and glucose. In patients, whohad already been diagnosed with DM, GH levels were measured in the fasting state andsubsequently every 30?min for 2?h. As hypopituitarism or treatment forhypopituitarism can influence carbohydrate metabolism, we did not include patientsrequiring such therapy.The prevalence of disturbed glucose metabolism was compared between patients withacromegaly and adults without acromegaly using the results of two population-basedstudies, during which study an OGTT was performed. The first study was performed in2006 among a random sample of the adult population living
机译：早期碳水化合物代谢紊乱（ECMD）和糖尿病（DM）通常与肢端肥大症相关。我们旨在评估患有肢端肥大症的ECMD住院患者的患病率，并通过两项基于人群的流行病学调查，将结果与未肢端肥大的成年人进行比较。我们评估了97例患有肢端肥大症的患者在其疾病的多个阶段（平均年龄为56岁，估计的肢端肥大症持续时间为12.5年）。对尚未诊断为DM的患者进行了口服葡萄糖耐量测试，以发现无症状的DM或ECMD（葡萄糖耐量受损+空腹血糖受损）。比较肢端肥大症患者和普通成年人（n = 435）与具有多种2型糖尿病危险因素（n = 314）的成年人的参与者之间的性别，年龄和BMI匹配。在51例肢端肥大症患者中诊断为DM（52.5％），占总人群的14.3％（P <0.001）。肢端肥大症患者的ECMD患病率也高于一般人群和高危人群。肢端肥大症患者中只有22％的血糖正常。与高危组相比，肢端肥大症患者新诊断出的ECMD或DM患病率高1.3-1.5倍。患有肢端肥大症的患有ECMD或DM的患者年龄较大，肥胖，病程更长，IGF1水平更高（Z评分）。 Logistic回归分析表明，葡萄糖变性的严重程度由年龄，BMI和IGF1水平预测。在肢端肥大症患者中，DM和ECMD的患病率大大超过了普通人群和高危人群，并且DM的发展取决于年龄，BMI和IGF1水平。关键词：肢端肥大症，葡萄糖，糖尿病，IGF1，流行病学简介在肢端肥大症患者中经常观察到葡萄糖代谢紊乱。在有关该主题的首批论文之一中，超过60％的肢端肥大患者发现了葡萄糖耐量异常（1） 。现在已知这些患者的葡萄糖异常包括糖尿病（DM），葡萄糖耐量（IGT）受损和空腹葡萄糖（IFG）受损，并且在Colao等人的评论中进行了广泛讨论（2）。更具体地看早期碳水化合物代谢紊乱（ECMD）-定义为IFG，IGT或其组合-肢端肥大症患者的患病率已显示在16％至46％之间（3、4、5）。尽管大多数流行病学研究表明ECMD的患病率高于明显的糖尿病（2、5、6、7），但并非所有研究都报告了相同的患病率（3,8）。肢端肥大症患者ECMD的发展和/或进展为糖尿病可能取决于几个因素，例如年龄和性别（5），生长激素（GH）的水平（9）以及肢端肥大的持续时间和持续时间。暴露于升高的GH水平（9，10）。但是，其他作者没有发现患有葡萄糖异常的人和血糖正常的人之间的GH水平和胰岛素样生长因子1（IGF1）水平或疾病持续时间没有差异（5，6，10,11）。糖尿病早期发展的另一个可能因素是DM的阳性家族史（5,12）。可能也影响葡萄糖干扰发展的最终因素是肢端肥大症的具体治疗方法。生长抑素类似物可能通过降低胰岛素分泌以及降低GH和IGF1水平来影响葡萄糖代谢（13，14）。本研究的目的是评估在莫斯科一家大型三级转诊中心接受肢端肥大症治疗的患者中ECMD和DM的患病率（ 15），并使用基于两个人群的调查将结果与没有肢端肥大症的成年人中此类葡萄糖紊乱的患病率进行比较（16、17）。我们还分析了导致高血糖发生的因素。对象和方法患者在莫斯科地区临床研究国家研究所的门诊总共对97名肢端肥大症患者进行了治疗或长期随访，他们接受了广泛的评估，包括身高，体重和血压。那些以前没有被诊断出患有DM的患者接受了口服葡萄糖耐量测试（OGTT）。在空腹状态下，口服75微克葡萄糖后30、60、90和120微分分钟，抽取血液用于同时测量GH和葡萄糖的血浆水平。在已经被诊断出患有DM的患者中，在禁食状态下测量GH水平，随后每30分钟检查2小时。由于垂体功能低下或垂体功能低下的治疗会影响碳水化合物的代谢，因此我们不包括需要这种治疗的患者。根据两项基于人群的研究结果，比较了肢端肥大症患者和没有肢端肥大症的成年人糖代谢异常的发生率，并进行了一项OGTT研究。第一项研究于2006年在随机抽样的成年人口中进行

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