Endocrine Abstracts

Introduction: Acromegaly is a chronic disease generally caused by a GH-secreting pituitary adenoma. GH excess causes insulin resistance and impair β cell function, predisposing patients with acromegaly to develop DM. Treatment of diabetes has been revolutionized since the introduction of sodium-glucose cotransporter inhibitors (SGLT2i). This novel class is widely used in type 2 diabetes mellitus (T2DM) and recently was approved for patients with heart failure with reduced ejection fraction and patients with chronic kidney disease (CKD) without diabetes. Taking into consideration the cardiorenal protection aspects, SGLT2i seems to be also attractive for diabetes management in acromegalic patients with already known increased cardiovascular risk. However, despite the known favorable aspects, SGLT2i is less recommended for acromegalic patients with diabetes due to the increased risk of diabetic ketoacidosis (DKA).

This study aims: To report data regarding the use of SGLT2i in patients with acromegaly and diabetes.

Methods: In the present case series, data was collected using an electronic computerized registry at Clalit Medical Health (CMH) Services from Western Galilee and Haifa district between the years 2000-2020. Charts of patients with acromegaly and diabetes were reviewed thoroughly for current and previous anti-diabetic and acromegaly medications. Notably, electronic computerized files enable health care practitioners to follow the monthly treatment dispensing and report drug side effects. Laboratory results for fasting plasm glucose (FPG), hemoglobin A1c, IGF-1, and GH were reported before SGLT2i administration. In addition, actual hemoglobin A1c, body mass index (BMI), duration of diabetes, tumor size was reported for patients with and without SGLT2i treatment.

Results: 34 acromegalic patients with diabetes were identified. Treatment with SGLT-2i was documented in nine patients, out of them 5 females and 4 males with a mean age (SD) of 61± 12 yr. The mean (SD) duration of treatment with SGLT2i was 27.5±7.3 months. Mean HbA1c before and after SGLT-2i initiation was 8.1±1.1% and 7.0±0.9% respectively. Mean IGF-1 level (SD) before SGLT-2i initiation was 177±68 ng/ml and the mean GH level (SD) was 0.7±0.5 μg/l. All nine patients are still under treatment with SGLT2i and none of them had reported any adverse reaction related to SGLT2i.

Conclsions: This study provides us for the first time with new data regarding the use of SGLT2i among acromegalic patients with diabetes. The use of SGLT2i among patients with already treated acromegaly and diabetes seems to be attractive.