ArticlesIncidence of diabetes mellitus and impaired glucose tolerance in children and adolescents receiving growth-hormone treatment
Introduction
Growth hormone (GH) contributes to insulin resistance but few studies have examined whether there is a relation in children between GH therapy and diabetes mellitus. In a retrospective study of nearly 2000 Japanese children who had received GH treatment for at least 6 months, only three were found to have glucose intolerance.1 Based on the limited information available in 1993, the European Society of Paediatric Endocrinology issued a statement that diabetes mellitus is rare among GH-treated children, with a prevalence that did not seem to differ from that of the population.2
Pharmacia and Upjohn International Growth Study (KIGS) is a large international pharmacoepidemiological survey principally designed to monitor efficacy and safety of GH therapy in children and adolescents. We analysed the database to determine the incidence of type 1 and 2 diabetes and impaired glucose tolerance (IGT) in this population.
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Methods
We investigated 85 reports to the KIGS database between 1987 and 1997 of diabetes mellitus, abnormal glucose tolerance, and hyperglycaemia. The clinician responsible for the patient was sent a detailed questionnaire to define the diagnosis. We recorded details of the date of diagnosis, presenting symptoms, family history of diabetes (at least one first-degree relative with the same type of diabetes), blood tests (measurements of antibodies, oral glucose-tolerance test) and risk factors for
Results
The age, sex, and diagnoses of the patients are shown in table 1. The total number of years of GH treatment was 52 375. 11 433 (49%) children had received more than 3 years of GH therapy.
Of the 85 reports of abnormal glucose tolerance, 42 were excluded because they did not meet the criteria for diagnosis of type 1 or type 2 diabetes, or IGT. The clinical and demographic details of the 43 (0·18%) children who developed type 1 or type 2 diabetes mellitus, or IGT during GH therapy are shown in
Discussion
We found that the incidence of type 1 diabetes mellitus in children and adolescents treated with GH therapy was not higher than the expected incidence in the population. It is difficult to compare our data with that from the National Cooperative Growth Study14 of GH treated children in the USA since this study did not distinguish between the different types of diabetes mellitus and only assessed patients during the period that recombinant GH was given, which excludes potential effects on
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