Concomitant type 2 diabetes increases mortality and morbidity risk in acromegaly patients

Sweden: Coexistence of diabetes increases the risk of overall mortality as well as cardiovascular mortality and morbidity in patients with acromegaly, states a study article published in the Journal of Clinical Endocrinology and Metabolism.

Acromegaly is a hormonal disorder caused by excess secretion of growth hormone (GH), generally, from the pituitary gland, that results in increased levels of insulin-like growth factor 1 (IGF-1). Chronic excess of IGF-1 leads to systemic comorbidities and increased mortality, mainly due to cardiovascular diseases. The goals for the treatment of acromegaly are therefore to achieve biochemical remission and to treat associated comorbidities. Impaired glucose metabolism is a common complication in acromegaly and the prevalence of diabetes mellitus ranges between 19% and 56% in patients with acromegaly. The incidence of diabetes in acromegaly is mainly driven by insulin resistance. Diabetes is a major risk factor for cardiovascular disease and death but its effect on outcomes in acromegaly is unknown.

Daniela Esposito, University of Gothenburg, Sweden, and colleagues conducted a study to determine whether diabetes affects morbidity and mortality in patients with acromegaly.

Investigators conducted a nationwide (Sweden), observational, matched-cohort study. The study included 254 patients with acromegaly and concomitant type 2 diabetes (ACRO-DM group) and 532 without diabetes (ACRO group). . The risk of overall mortality and cardiovascular mortality and morbidity were estimated using Cox regression. Overall, the mean follow-up was 9.2 years.

Key findings of the study,

• Mean age at baseline was 62.6 and 60.0 years and the mean duration of acromegaly was 6.8 and 6.0 years in the ACRO-DM and ACRO groups, respectively

• The unadjusted overall mortality rate per 1000 person-years was 35.1 and 20.1 in the ACRO-DM and ACRO groups respectively.

• The hazard ratio (HR) for overall mortality adjusted for multiple confounders was 1.58 in the ACRO-DM group compared with the ACRO group.

• Cardiovascular mortality (HR 2.11) and morbidity (HR 1.49) were also increased in the ACRO-DM group.

Investigators concluded that the present study is the first analysis of the effect of diabetes on long-term outcomes in patients with acromegaly. The results show that the presence of diabetes in patients with acromegaly is associated with excess overall and cardiovascular mortality and increased risk of cardiovascular disease in comparison with those without diabetes.

The study findings highlight the importance of optimizing the management strategy of acromegaly to prevent the development of diabetes, the investigators commented.

Reference:

Daniela Esposito, Daniel S Olsson, Stefan Franzén, Mervete Miftaraj, Jonatan Nåtman, Soffia Gudbjörnsdottir, Gudmundur Johannsson, Effect of Diabetes on Morbidity and Mortality in Patients With Acromegaly, The Journal of Clinical Endocrinology & Metabolism, 2022;, dgac400, https://doi.org/10.1210/clinem/dgac400