Endocrine Abstracts

Management of type 2 diabetes (T2DM) has advanced since introducing sodium-glucose co-transporter 2 inhibitors (SGLT2i) with their protective cardiovascular and renal effects. However, in acromegaly patients with diabetes, the SGLT2i class is less attractive among endocrinologists because of the increased risk of diabetic ketoacidosis (DKA), and the use of incretin-based therapy as second-line treatment after metformin is more considered. This review aims to discuss the role of SGLT2i in diabetes management in acromegaly.

Methods: A comprehensive Medline/PubMed and Embase search was performed between 2012-2022 using the terms acromegaly and diabetes, SGLT2i in acromegaly, DKA in patients with acromegaly with and without SGLT2i use.

Results: Database evidence regarding the use of SGLT2i in acromegaly patients with diabetes is scanty. Previously reported data disclosed that in most cases, DKA was not related to SGLT2i, and this complication was reported as a presenting manifestation in most patients with uncontrolled acromegaly and diabetes. It is worth mentioning that GH and IGF-1 levels were markedly elevated in all reported cases of developed DKA. In contrast, in our previously reported data, the use of SGLT2i in controlled acromegaly was safe and without adverse events. Therefore, in this review, we consider acromegaly disease activity an essential criterion in the proposed algorithm for diabetes management in acromegaly patients, particularly when considering treatment with SGLT2i.

Conclusion: We recommend using SGLT2i among patients with controlled acromegaly and diabetes, following the T2DM recommendation guidelines. However, SGLT2i could be considered cautiously among partially controlled acromegaly patients and not recommended in poorly controlled patients. In these cases, incretin-based therapy is more favorable for patients, at least until the availability of future studies demonstrating SGLT2i safety also in this context. Zaina A, Prencipe N, Golden E, Berton AM, Arad E, Abid A, Shehadeh J, Kassem S, Ghigo E. How to position sodium-glucose co-transporter 2 inhibitors in the management of diabetes in acromegaly patients. Endocrine 2023;80: 491- 499