The effect of growth hormone (GH) replacement on blood glucose homeostasis in adult nondiabetic patients with GH deficiency: real-life data from the NordiNet® International Outcome Study

ObjectiveTo assess the effect of 4 years' growth hormone (GH) replacement on glucose homeostasis and evaluate factors affecting glycosylated haemoglobin (HbA(1c)) in adults with growth hormone deficiency (GHD). DesignNordiNet((R)) International Outcome Study, a noninterventional study, monitors long-term effectiveness and safety of GH replacement [Norditropin((R)) (somatropin), Novo Nordisk A/S] in real-life clinical practice. PatientsNondiabetic patients (n = 245) with adult-onset GHD (age 20 years at GH start), 4 years' GH replacement and HbA(1c) values at baseline and 4 years were included in the analysis. MeasurementsChanges from baseline () to 4 years in HbA(1c), fasting plasma glucose (FPG), IGF-I, lipids (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglycerides), waist circumference, glycaemic (HbA(1c) <57%; HbA(1c), 57-65%; HbA(1c), 65%) and metabolic health status were evaluated. Effects of baseline HbA(1c), gender, baseline age, average GH dose and baseline body mass index (BMI) on HbA(1c) were investigated. The models were adjusted for concomitant medication use. ResultsMean (standard deviation) baseline HbA(1c) was 513 (065)% and remained at the same level at 4 years. Age at treatment start (P = 00094) and BMI (P = 00008) had a significant impact on HbA(1c). At 4 years, 85% of patients with HbA(1c) <57% (normal levels) at baseline and 55% of patients with HbA(1c) 57-65% (impaired glucose tolerance) at baseline remained in the same glycaemic health category. Nineteen patients improved from impaired glucose tolerance to normal HbA(1c). Seven patients developed diabetes. ConclusionsThese data demonstrate that 4 years' GH replacement therapy did not adversely affect glucose homeostasis in the majority of adults with GHD.