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Can glucose intolerance and/or diabetes be predicted in patients treated with rhGH?
1Department of Pediatrics, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands.
Insights
Recombinant human growth hormone (rhGH) therapy helps children grow but may increase insulin levels. Long-term effects on glucose metabolism in renal patients require further study.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Metabolic Research
Background:
- Recombinant human growth hormone (rhGH) therapy is effective for growth retardation in children with chronic renal insufficiency (CRI) and after renal transplantation (RTx).
- Concerns exist regarding rhGH's impact on glucose homeostasis and insulin action, especially in renal patients with pre-existing insulin resistance.
Purpose of the Study:
- To evaluate the effects of rhGH therapy on glucose tolerance and insulin action in children with CRI and post-RTx.
- To assess the safety and long-term implications of rhGH treatment on carbohydrate metabolism in these pediatric populations.
Main Methods:
- Analysis of data from studies involving rhGH therapy in children with CRI and post-RTx.
- Monitoring of glucose tolerance and plasma insulin levels before and during rhGH treatment (4 IU/m²/day for one year).
Main Results:
- rhGH therapy did not impair glucose tolerance in either patient group after one year.
- Significant increases in plasma insulin levels were observed during rhGH therapy (p < 0.001).
- No patients developed impaired glucose tolerance or permanent diabetes mellitus (DM), but euglycemia was maintained via compensatory hyperinsulinemia.
Conclusions:
- rhGH therapy appears safe in the intermediate term for growth acceleration in renal patients.
- Long-term consequences of compensatory hyperinsulinemia due to rhGH therapy are unknown.
- Further long-term studies are necessary to monitor carbohydrate metabolism and assess the risk of impaired glucose tolerance or DM in susceptible renal patients.
Abstract:
Various studies have convincingly shown that recombinant human growth hormone (rhGH) therapy accelerates growth significantly in children with growth retardation secondary to chronic renal insufficiency (CRI) and after renal transplantation (RTx). rhGH therapy appeared remarkably safe intermediate-term, but paediatricians are concerned about the potential adverse effects on glucose homeostasis and insulin action. Particularly in children with CRI and after RTx, pre-existing insulin resistance may be aggravated by exogenous rhGH therapy. Patients after RTx had significantly higher pretreatment insulin levels than controls (p < 0.001). Various studies in both patient groups showed that one year of rhGH therapy at 4 i.u./m2/day did not impair glucose tolerance but significantly increased plasma insulin levels (p < 0.001). No patients developed impaired glucose tolerance or permanent diabetes mellitus (DM), but from these studies, it was concluded that euglycemia was maintained at the expense of increased insulin levels. The long-term consequences of the compensatory hyperinsulinaemia are not yet known. Although permanent DM has not been reported in any of the rhGH trials in renal patients, it cannot be excluded that some patients with CRI or after RTx may develop impaired glucose tolerance and/or permanent DM during long-term rhGH therapy, particularly those with risk factors such as familial type II DM and obesity. Long-term studies, including careful monitoring of carbohydrate metabolism, are required.