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Reduced insulin sensitivity during growth hormone therapy for short children born small for gestational age
Wayne S Cutfield1, Wendy E Jackson, Craig Jefferies
1Department of Paediatrics, the Liggins Institue for Medical Research, University of Auckland, Auckland, New Zealand.
Insights
Recombinant human growth hormone (rhGH) therapy reduced insulin sensitivity in short children born small for gestational age (SGA). This reduction persisted even after rhGH therapy was discontinued.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Growth Hormone Therapy
Background:
- Children born small for gestational age (SGA) often exhibit reduced insulin sensitivity.
- Growth hormone deficiency can impact growth and metabolic parameters.
Purpose of the Study:
- To investigate the effect of recombinant human growth hormone (rhGH) therapy on insulin sensitivity in short children with SGA.
- To determine if insulin sensitivity recovers after rhGH therapy cessation in this population.
Main Methods:
- A cohort of 12 short, non-GH-deficient SGA children (9.3 +/- 1.0 years) received daily rhGH therapy (20 IU/m(2) per week) for 21 +/- 6 months.
- Insulin sensitivity was measured using Bergman's minimal model before, during, and 3 months after rhGH therapy suspension in prepubertal children.
- Pubertal status remained unchanged throughout the study period.
Main Results:
- rhGH therapy led to a significant 44% decrease in insulin sensitivity (P =.018) and a 123% increase in acute insulin response (P <.009).
- In 5 children, insulin sensitivity remained significantly reduced 3 months after stopping rhGH therapy (11.5 vs. 10.7 units).
- No recovery of insulin sensitivity was observed after rhGH discontinuation.
Conclusions:
- rhGH therapy exacerbates the pre-existing reduced insulin sensitivity in short SGA children.
- The negative impact on insulin sensitivity persists even after rhGH therapy is stopped.
- These findings suggest careful monitoring of metabolic status during and after rhGH treatment in SGA children.
Objectives:
To examine the influence of recombinant human growth hormone (rhGH) therapy on insulin sensitivity in short children born small for gestational age (SGA).
Study Design:
Twelve short (height standard deviation score, -3.2 +/- 0.1) non-GH-deficient children SGA (7 boys/5 girls) were studied at 9.3 +/- 1.0 years of age. The insulin sensitivity index was measured with Bergman's minimal model before (11 children) and during (12 children) rhGH therapy (21 +/- 6 months) administered daily at 20 IU/m(2) per week. No child had a change in pubertal status during the study. In addition, 5 children who remained prepubertal had insulin sensitivity remeasured 3 months after rhGH therapy was suspended.
Results:
With rhGH therapy, insulin sensitivity fell 44% +/- 10% (P =.018), with a compensatory rise in the acute insulin response of 123% +/- 59% (P <.009). Reassessment of insulin sensitivity in 5 children (3 boys/2 girls) 3 months after suspension of rhGH occurred at 9.9 +/- 0.7 years. Insulin sensitivity remained unchanged after rhGH therapy was stopped: 31.6 (20.5-42.3) before treatment, 11.5 (5.7-24.4) with treatment, and 10.7 (6.2-16.9) 10(-4). min(-1) microU/mL after treatment.
Conclusions:
Children SGA are known to have reduced insulin sensitivity. There was a further reduction in insulin sensitivity with rhGH therapy that did not recover 3 months after rhGH therapy was stopped.