Presence of type 2 diabetes in acromegaly increases mortality and morbidity risks
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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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Niki Karavitaki, MSc, PhD, FRCP
Abnormalities in glucose metabolism, mainly attributed to insulin resistance, are a common complication for patients with acromegaly, and diabetes is reported for between 19% and 56% of acromegaly cases. Esposito and colleagues investigated the impact of diabetes on the cardiovascular morbidity and mortality, as well as overall mortality, of patients with acromegaly.
In this well performed study, the authors provide data on the negative sequelae of co-existent diabetes in the prognosis of patients with acromegaly. Patients with concomitant type 2 diabetes had around 60% higher overall mortality and around 2-fold higher cardiovascular mortality than those without diabetes. These results highlight the importance of taking diabetes into account in the treatment strategy of acromegaly.
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