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- Jensen, Rikke Beck, et al.
(författare)
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A randomised controlled trial evaluating IGF-I titration in contrast to current GH dosing strategies in children born Small for Gestational Age (NESGAS).
- 2014
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Ingår i: European Journal of Endocrinology. - 1479-683X. ; 171:4, s. 509-518
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Tidskriftsartikel (refereegranskat)abstract
- Background: Short children born small for gestational age (SGA) are treated with growth hormone (GH) dose based on body size, but treatment may lead to high levels of IGF-I. The objective was to evaluate IGF-I titration of GH dose in contrast to current dosing strategies. Methods: In the North European Small for gestational age study (NESGAS) 92 short pre-pubertal children born SGA were randomised after one year of high dose GH treatment (67µg/kg/day) to three different regimens: high-dose (67µg/kg/day), low-dose (35µg/kg/day) or IGF-I titration. Results: The average dose during the second year of the randomised trial did not differ between the IGF-I titration group (38µg/kg/day, SD 0.019) and the low-dose group (35µg/kg/day, SD 0.002) (P=0•46), but there was a wide variation in the IGF-I titration group (range 10-80µg/kg/day). The IGF-I titration group had significantly lower height gain (0.17SDS, SD 0.18) during the second year of the randomised trial compared to the high-dose group (0.46SDS, SD 0.25) but not significantly lower than the low-dose group (0.23SDS, SD 0.15) (p=0.17). The IGF-I titration group had lower IGF-I levels after two years of the trial (mean 1.16, SD 1.24) compared to both the low-dose (mean 1.76, SD 1.48) and the high-dose (mean 2.97, SD 1.63) groups. Conclusion: IGF-I titration of GH dose in SGA children proved less effective than current dosing strategies. IGF-I titration resulted in physiological IGF-I levels with a wide range of GH dose and a poorer growth response, which indicates the role of IGF-I resistance and highlights the heterogeneity of short SGA children.
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| 2. |
- Jensen, Rikke Beck, et al.
(författare)
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Baseline IGF-I Levels Determine Insulin Secretion and Insulin Sensitivity during the First Year on Growth Hormone Therapy in Children Born Small for Gestational Age. Results from a North European Multicentre Study (NESGAS)
- 2013
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Ingår i: Hormone Research in Paediatrics. - : S. Karger AG. - 1663-2826 .- 1663-2818. ; 80:1, s. 38-46
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Developmental programming alters growth and metabolic outcome in children born small for gestational age (SGA). We explored insulin and glucose metabolism in SGA children treated with a fixed GH dose over 1 year. Methods: In the North European Small for Gestational Age Study (NESGAS), 110 short SGA children received GH at 67 mu g/kg/day for 1 year. Insulin secretion was assessed by acute insulin response (AIR), insulin sensitivity (IS) by HOMA and disposition index (DI) by insulin secretion adjusted for IS. Results: First-year GH therapy led to increases in height and IGF-I standard deviation score (SDS), and reductions in IS (p < 0.0001). Compensatory increases in AIR (p < 0.0001) were insufficient and resulted in reduced DI (p = 0.032). Children in the highest IGF-I SDS tertile at baseline were the least insulin sensitive at baseline (p = 0.024) and 1 year (p = 0.006). IGF-I responses after 1 year were positively related to AIR (r = 0.30, p = 0.007) and DI (r = 0.29, p = 0.005). Conclusion: In SGA children treated with a high GH dose for 1 year, baseline IGF-I levels were related to IS whilst gains in height and IGF-I responses were associated with insulin secretion. Defining heterogeneity in IGF-I in SGA children may be useful in predicting growth and metabolic response. Copyright (C) 2013 S. Karger AG, Basel
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