Combined therapy with insulin and growth hormone in 17 patients with type-1 diabetes and growth disorders
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Stefano Zucchini1, Dario Iafusco, Silvia Vannelli
1Department of Pediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy.
Insights
Most Italian doctors avoid combined growth hormone (GH) and insulin therapy for children with short stature and type-1 diabetes (T1DM). However, this study found the combined therapy feasible, effective for growth, and safe for metabolic control.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Growth Hormone Therapy
Background:
- Combined growth hormone (GH) and insulin therapy is infrequently prescribed by pediatric endocrinologists.
- Physician attitudes towards this combined therapy for short stature in type-1 diabetes (T1DM) are not well understood.
Purpose of the Study:
- To investigate the attitudes of Italian physicians regarding the prescription of combined GH and insulin therapy.
- To assess the feasibility, safety, and efficacy of this combined therapy in children with short stature and T1DM.
Main Methods:
- A national questionnaire survey was distributed to Italian pediatric endocrinologists.
- Data on growth and diabetes management were collected for patients receiving combined GH and insulin therapy.
Main Results:
- Data from 42 centers indicated that 29 centers typically avoided combined therapy.
- Seventeen patients were identified receiving combined therapy; GH therapy was effective for growth (Height SDS range: -0.3 to +3.1).
- In patients receiving GH after T1DM onset, insulin dose increased (0.7 to 1.0 U/kg), but HbA1c remained stable.
Conclusions:
- Most Italian physicians are hesitant to prescribe combined GH-insulin therapy for diabetic children with growth issues.
- The study demonstrated that combined therapy is feasible and effective for growth, with only mild insulin resistance observed.
- GH therapy promoted growth in most patients without negatively impacting diabetes metabolic control.
Background/Aim:
Combined growth hormone (GH) and insulin therapy is rarely prescribed by pediatric endocrinologists. We investigated the attitude of Italian physicians to prescribing that therapy in the case of short stature and type-1 diabetes (T1DM).
Methods:
A questionnaire was sent and if a patient was identified, data on growth and diabetes management were collected.
Results:
Data from 42 centers (84%) were obtained. Of these, 29 centers reported that the use of combined therapy was usually avoided. A total of 17 patients were treated in 13 centers (GH was started before T1DM onset in 9 patients and after the onset of T1DM in 8). Height SDS patterns during GH therapy in the 11 patients affected by GH deficiency ranged from -0.3 to +3.1 SDS. In the 8 diabetic patients in whom GH was added subsequently, mean insulin dose increased during the first 6 months of therapy from 0.7 ± 0.2 to 1.0 ± 0.2 U/kg (p = 0.004). HbA1c was unchanged during the first 6 months of combined therapy.
Conclusions:
Most Italian physicians do not consider prescribing the combined GH-insulin therapy in diabetic children with growth problems. However, the results of the 17 patients identified would confirm that the combined therapy was feasible and only caused mild insulin resistance. GH therapy was effective in promoting growth in most patients and did not affect diabetes metabolic control.
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