Growth hormone treatment does not to lead to insulin resistance nor excessive rise in IGF-1 levels, while improving height in patients small for gestational age A long-term observational study

Abstract

Objective :In children born small for gestational age (SGA), the relationship betweengrowth hormone (GH) treatment and insulin resistance (IR) has only been investigated fora short period, necessitating a longer observation period. This study aimed to evaluate thelong‐term (10 years) effect of GH to SGA‐children on IR and safety during treatment.Design:This was a multicenter observational study.Patients:SGA‐children who received GH treatment in Spain (stratified by Tanner‐stage and age at GH onset [two groups:≤6 years old or >6 years old]).Measurements:The analysed variables (yearly measures) included auxologic, meta-bolic (insulin‐like growth factor‐1 (IGF‐1), height velocity [HV], weight and homeo-static model assessment‐IR [HOMA‐IR]) and safety data. Data were collectedprospectively (since the study approval: 2007) and retrospectively (since the initia-tion of GH treatment: 2005–2007).Results:A total of 389 SGA children (369 Tanner‐I) were recruited from 27 centres.The mean age (standard deviation) of the children at GH treatment onset was 7.2(2.8) years old. IGF‐1 (standard deviation score [SDS]) and HOMA‐IR values tendedto increase until the sixth year of GH‐treatment, with significant differences beingobserved only during the first year, while these remained stable in the later years(within normal ranges). Height (SDS) increased significantly (basal:−3.0; tenthyear:−1.13), and the maximum HV (SDS) occurred during the first year (2.75 ± 2.39).Conclusions:HOMA‐IR values increased significantly in SGA‐children during thefirst year of GH‐treatment, remained stable and were within normal ranges in allcases. Our 10‐year data suggests that long‐term GH treatment does not promote IRand is well‐tolerated, safe and effective.