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Effects of Somatostatin Analogues on Glucose Homeostasis Have Limited Clinical Impact in Patients With Acromegaly: Presented at ECE
Sat, May 9th 2009 01:00 pm
http://www.docguide.com/news/content.nsf/news/852571020057CCF6852575A90076BFD7 [ View Original Article ]
ISTANBUL, Turkey -- May 1, 2009 --
Modifications of glucose homeostasis induced by somatostatin analogues
(SSAs) have an overall minor clinical impact in patients with
acromegaly, according to a meta-analysis presented here on April 28 at
the 11th European Congress of Endocrinology (ECE)."Somatostatin analogues are drugs that are widely used in medical therapy, and particularly for the medical treatment of acromegaly," said principal investigator Andrea Giustina, MD, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
However, they can also influence glucose metabolism through inhibitory effects on insulin secretion, and "one possible side effect is secondary diabetes," said Dr. Giustina.
As 1 of the major indications for SSA therapy, trials of acromegaly have remained few and relatively short-term, and have often shown very different results concerning diabetes.
Therefore, Dr. Giustina and colleagues conducted a meta-analysis from published, long-term trials in acromegaly to assess the clinical impact of SSAs on glucose metabolism.
The outcomes analysed across these trials were: fasting plasma glucose concentration (FPG), fasting plasma insulin concentration (FPI), haemoglobin A1C (Hb A1C), and plasma glucose during the oral glucose tolerance test (OGTT).
A total of 31 studies were included in the meta-analysis. Trials were eligible if they included SSA treatment duration >3 weeks, if data were available for at least 1 of the 4 outcomes being analysed, and if there was no selection of patients with acromegaly for their responsiveness to SSAs.
SSA treatment was seen to induce a statistically significant decrease in FPI (effect size, -0.45; 95% confidence interval [CI], -0.58 to -0.32; P = .00001). However, as Dr. Giustina said, "They apparently do not change either blood glucose levels [FPG; effect size, 0.04; 95% CI, -0.07 to 0.15, P = .52] or Hb A1C, which is a parameter for the control of diabetes [effect size, 0.11; 95% CI, -0.02 to 0.23, P = .09]."
During the OGTT, the serum glucose levels were seen to change significantly, although with great inconsistency across the trials (effect size, 0.31; 95% CI, 0.17-0.45; P = .01).
Dr. Giustina indicated that these modifications in glucose homeostasis induced during treatment with SSAs have an overall minor clinical impact on patients with acromegaly. Thus they believe that the effect is mainly due to reduced insulin resistance with SSA treatment.
At the same time, he stressed that, "this does not mean that in single patients you may have a deterioration of blood glucose, and therefore monitoring is important."
[Presentation title: Effects of Somatostatin Analogues on Glucose Homeostasis: A Meta-Analysis of Acromegaly Studies. Abstract P570]
