Different effects of intraperitoneal and subcutaneous insulin administration on the GH-IGF-1 axis in type 1 diabetes.

Different effects of intraperitoneal and subcutaneous insulin administration on the GH-IGF-1 axis in type 1 diabetes.

J Clin Endocrinol Metab. 2016 Apr 26;:jc20161473

Authors: van Dijk PR, Logtenberg SJ, Chisalita SI, Hedman CA, Groenier KH, Gans RO, Kleefstra N, Arnqvist HJ, Bilo HJ

Abstract
CONTEXT: In type 1 diabetes mellitus (T1DM), low levels of insulin-like growth factor -1 (IGF-1) and IGF binding protein-3 (IGFBP-3) and high levels of growth hormone (GH) and IGFBP-1 are present, probably due to portal vein insulinopenia.
OBJECTIVE: To test the hypothesis that continuous intraperitoneal insulin infusion (CIPII) has a more pronounced effect than subcutaneous (SC) insulin therapy on regulation of the GH-IGF-1 axis.
DESIGN: Prospective, observational case-control study. Measurements were performed twice at a 26-week interval.
SETTING: Two secondary care hospitals in the Netherlands.
PATIENTS: A total of 184 patients, age and gender matched, of which 39 used CIPII and 145 SC insulin therapy for the past 4 years.
OUTCOMES: Primary endpoint included differences in IGF-1. Secondary outcomes were differences in GH, IGFBP-1 and IGFBP-3.
RESULTS: IGF-1 was higher with CIPII as compared to SC insulin therapy: 124 μg/l (95% CI 111, 138) versus 108 μg/l (95% CI 102, 115) (p=0.035). Additionally, IGFBP-3 concentrations were higher and IGFBP-1 and GH concentrations were lower with CIPII as compared to SC insulin therapy: 3.78 mg/l (95% CI 3.49, 4.10) versus 3.31 mg/l (95% CI 3.17, 3.47) for IGFBP-3, 50.9 μg/l (95% CI 37.9, 68.2) versus 102.6 μg/l (95% CI 87.8, 119.8) for IGFBP-1 and 0.68 μg/l (95% CI 0.44, 1.06) versus 1.21 μg/l (95% CI 0.95, 1.54) for GH, respectively. In multivariate analysis, IGF-1 had no significant association with HbA1c.
CONCLUSIONS: The GH-IGF-1 axis may be affected by the route of insulin administration with CIPII counteracting dysregulation of the GH-IGF1 axis present during SC insulin therapy.

PMID: 27115061 [PubMed - as supplied by publisher]

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