Presence of type 2 diabetes in acromegaly increases mortality and morbidity risks
Among adults with acromegaly, concomitant type 2 diabetes was associated with increased risks for overall mortality and for cardiovascular mortality and morbidity, researchers reported in The Journal of Clinical Endocrinology & Metabolism.
“Type 2 diabetes is associated with excess risk of death and cardiovascular diseases, which is related to metabolic control, diabetes duration and diabetes-related complications, such as macrovascular diseases, nephropathy, neuropathy and retinopathy,”
Daniela Esposito, MD, of the department of endocrinology at Sahlgrenska Academy at University of Gothenburg, Sweden, and colleagues wrote.
- “How and to what extent concomitant diabetes influences morbidity and mortality in patients with acromegaly is not known.”
In the nationwide, observational, matched-cohort study, researchers assessed data from 254 people with acromegaly and concomitant type 2 diabetes (mean age, 62.6 years; 51.2% women) between 1987 and 2020 who were identified in the Swedish National Patient Registry and the National Diabetes Registry and Drug Registry. Patients were matched with 532 people with acromegaly but without diabetes (mean age, 60 years; 45.9% women).
At baseline, mean acromegaly duration was 6.8 years among people with concomitant diabetes and 6 years among the matched cohort (P = .098). Mean diabetes duration at baseline was 2.4 years.
During a mean follow-up of 9.2 years, researchers observed an unadjusted overall mortality rate of 35.1 per 1,000 person-years among people with concomitant diabetes and 20.1 per 1,000 person-years among the matched cohort.
The mortality rate for CV-caused mortality was 9.6 per 1,000 person-years among people with concomitant diabetes compared with 4.5 per 1,000 person-years among the matched cohort.
People with concomitant diabetes had increased risks for overall mortality (HR = 1.58; 95% CI, 1.12-2.23) and CV mortality (HR = 2.11; 95% CI, 1.09-4.10) and morbidity (HR = 1.49; 95% CI, 1.21-1.82) when adjusted for multiple confounders compared with the matched cohort without diabetes.
“Our findings highlight the importance of optimizing management of acromegaly to prevent the development of diabetes,” the researchers wrote.
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Effect of Diabetes on Morbidity and Mortality in Patients With Acromegaly
Daniela Esposito, Daniel S Olsson, Stefan Franzén, Mervete Miftaraj, Jonatan Nåtman, Soffia Gudbjörnsdottir, Gudmundur Johannsson
The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 9, September 2022, Pages 2483–2492, https://doi.org/10.1210/clinem/dgac400
Diabetes is a major risk factor for cardiovascular disease and death but its effect on outcomes in acromegaly is unknown.
This work aimed to study whether diabetes affects morbidity and mortality in patients with acromegaly.
A nationwide (Sweden), observational, matched-cohort study was conducted. Patients diagnosed with acromegaly between 1987 and 2020 were identified in the Swedish National Patient Registry and those with concomitant type 2 diabetes in the National Diabetes Registry and Drug Registry. The risk of overall mortality, and cardiovascular mortality and morbidity were estimated using Cox regression.
The study included 254 patients with acromegaly and concomitant type 2 diabetes (ACRO-DM group) and 532 without diabetes (ACRO group). Mean (SD) age at baseline was 62.6 (11.4) and 60.0 (12.1) years (P = .004) and the mean (SD) duration of acromegaly was 6.8 (8.1) and 6.0 (6.2) years (P = .098) in the ACRO-DM and ACRO groups, respectively. Overall mean follow-up was 9.2 years.
The unadjusted overall mortality rate per 1000 person-years was 35.1 (95% CI, 27.2-44.7) and 20.1 (95% CI, 16.5-24.3) in the respective groups.
The hazard ratio (HR) for overall mortality adjusted for multiple confounders was 1.58 (95% CI, 1.12-2.23) in the ACRO-DM group compared with the ACRO group. Cardiovascular mortality (HR 2.11; 95% CI, 1.09-4.10) and morbidity (HR 1.49; 95% CI, 1.21-1.82) were also increased in the ACRO-DM group.
The presence of diabetes in patients with acromegaly was associated with increased overall mortality as well as increased cardiovascular mortality and morbidity.
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