Diabetes Can Increase Mortality, Morbidity in Acromegaly

New research from investigators in Sweden is providing clinicians with insight into the additional risk of mortality associated with a diagnosis of diabetes in patients with acromegaly.

Using data from a national patient registry, investigators provide evidence suggesting patients with acromegaly who also had diabetes had a 58% greater risk of overall mortality and a more than 2-fold increase in risk of cardiovascular mortality than their counterparts without diabetes.

“This study is the first analysis of the impact of diabetes on long-term outcomes in patients with acromegaly. We have shown that coexistence of diabetes is associated with excess overall and cardiovascular mortality and increased risk of cardiovascular disease in comparison with patients with acromegaly without diabetes,” wrote investigators. “Our findings highlight the importance of optimizing management of acromegaly to prevent the development of diabetes.”

Led by Daniela Esposito, MD, of the Sahlgrenska Academy at the University of Gothenburg, the current study was launched by a team of investigators from multiple institutions across Sweden who cited a paucity of data related to the impact of diabetes on risk of adverse outcomes, specifically cardiovascular disease and death, among patients with acromegaly. With this in mind, the study was designed as an observational, matched-cohort study leveraging data recorded within the Swedish National Patient Registry, the National Diabetes Registry, and National Drug Registry from 1987-2020 to identify patients with acromegaly with and without diabetes for inclusion.

Overall, 684 patients with acromegaly were identified. Of these, 150 patients developed diabetes after a diagnosis of acromegaly and were excluded from analyses. Of the 534 patients remaining, investigators had identified 532 with acromegaly and without diabetes and 254 patients with acromegaly and diabetes for inclusion in their analyses. At baseline, those with acromegaly and diabetes had a mean age of 62.6 (SD, 11.4) years and a mean duration of acromegaly of 6.8 (SD, 8.1) years. Among those with acromegaly without diabetes, the mean age at baseline was 60.0 (SD, 12.1) years and the mean duration of acromegaly was 6.0 (SD, 6.2) years.

The primary outcome of interest for the investigators’ analysis was the risk of overall mortality. Secondary outcomes of interest included the risk of cardiovascular mortality and risk of cardiovascular morbidity. Investigators also noted plans for assessments of individual risk factors for mortality and morbidity in patients with diabetes, including the impact of age, sex, disease duration, HbA1c levels, renal function, medication use, and BMI.

In unadjusted analyses, the overall mortality rate per 1000 person-years was greater among the acromegaly with diabetes group (35.1 [95% CI, 27.2-44.7]) than the acromegaly alone group (20.1 [95% CI, 16.5-24.3]). In propensity score-adjusted analyses, results indicated the risk of overall mortality was 58% greater among those with diabetes and acromegaly than those with acromegaly alone. Additionally, further analysis demonstrated these patients also had an increased risk of cardiovascular mortality (HR, 2.11 [95% CI, 1.09-4.10]) and morbidity than their counterparts with acromegaly but without diabetes.

This study, “Impact of Diabetes on Morbidity and Mortality in Patients with Acromegaly,” was published in the Journal of Clinical Endocrinology and Metabolism.