Predictors of Recovery of Glucose Intolerance following Treatment of Acromegaly: A Prospective Study Over a Decade

Objective The natural history of glucose intolerance (GI) in patients with acromegaly undergoing surgical treatment has not been fully understood. This study was aimed to unravel the prevalence and predictors of recovery from GI in these patients in a prospective multivariate model.

Methods Patients with acromegaly treated between 2007 and 2016 were prospectively studied with respect to demographics, clinic-radiological features, comorbidities, and hormonal investigations prior to surgery and at regular follow-up. The independent predictors of recovery from diabetes were analyzed.

Results There were a total of 151 active acromegaly patients included in the study. The median baseline GH and IGF-1 levels were 25 and 811 ng/mL, respectively. Diabetes mellitus (DM) and prediabetes were noted in 93 (61.6%) and 20 (13.2%) patients, respectively. Following surgical treatment, the median HbA1c decreased significantly from 6.4% (4.3−18%) to 5.5% (p < 0.001), with 46.8% having complete recovery from DM or prediabetes. This glycemic recovery had significant association with both biochemical (p = 0.001) and radiological remission (p = 0.01). The recovery from DM had a greater association with IGF-1 than with GH, especially among those with discordant GH and IGF-1 levels (60% in normal IGF-1 and high GH vs. 20% in high IGF-1 and normal GH) postoperatively. Postoperative IGF-1 had significant impact on recovery from DM (p = 0.01) independent of age, body mass index (BMI), duration of DM, and preoperative HbA1c.

Conclusion Nearly half of acromegaly patients with DM or prediabetes had glycemic recovery, influenced by biochemical and radiologic remission. Postoperative IGF-1 appears to be the strongest independent determinant of recovery from DM.

Publication History

Publication Date:
02 February 2018 (online)