Mechanisms of development of carbohydrate metabolism disturbances in acromegalic patients depending on treatment

Abstract

110 acromegalic patients were examined: 62 patients with newly diagnosed acromegaly (de novo), 25 patients were receiving somatostatin analogues treatment (SSA) and 23 patients underwent transsphenoidal sugery (TSS). The prevalence of carbohydrate metabolism disturbances (CMDs) in groups de novo, the SSA and the TSS was 53.3, 88.0 and 43.4%, respectively. Levels of fasting plasma insulin (FPI), index of insulin resistance (HOMA-IR index) did not differ in groups SSA and TSS and were more than 1.5 times lower than in the de novo group (p<0.05). Аrea under insulin curve in the first 30 minutes (AUC ins.30) of oral glucose tolerance test in the SSA group was 5.3 times lower than in the TSS, and 6.7 times lower than in the de novo group (p<0.05). Among the 23 de novo patients controlled acromegaly in 6 months was at 46% in group SSA and 50% of patients TSS. In the SSA group there were found increase of fasting plasma glucose levels (FPG), HbA1c (p=0.05), in the TSS group - decrease of FPG (p<0.05). There were the tendency to decrease of HOMA-IR (p=0.06), decrease of FPI and AUCins. (p<0.05) in SSA and TSS groups. Extent of decrease in AUCins.30 on SSA therapy exceeded the extent of decrease in UC ins.30-120 (in 11.0 and 2.3 times, respectively, p<0.05), but after TSS - these changes were comparable (2.4 and 3.2 times, respectively, p<0.05). Despite comparable reduction in insulin resistance on SSA therapy and after TSS decrease of the first phase of insulin secretion on SSA therapy leads to the development of CMD.