Growth Hormone Treatment in SGA Children Impairs Glucose-Insulin Metabolism Similar to Obesity
Overview
Children born small for gestational age (SGA) treated with growth hormone (GH) exhibit insulin resistance and impaired glucose metabolism comparable to children with obesity. GH therapy exacerbates these metabolic disturbances, with a higher prevalence of prediabetes observed in GH-treated SGA children than in those with isolated GH deficiency or obesity.
Background
Children born SGA have increased risks of insulin resistance, type 2 diabetes, and cardiovascular disease later in life. GH treatment is approved for SGA children lacking catch-up growth to improve stature but may negatively impact glucose-insulin metabolism. GH antagonizes insulin action, promoting insulin resistance, which can predispose to diabetes. Prior studies have not directly compared glucose metabolism in GH-treated SGA children with those having isolated GH deficiency or obesity using comprehensive testing.
Data Highlights
Group
Insulin AUC
HOMA-IR
Matsuda Index
HbA1c (%)
Prediabetes Prevalence (%)
SGA-GHT (Treatment-naïve)
Higher than iGHD (P = .002)
Higher than iGHD (P < .001)
Lower than iGHD (P < .001)
5.26 ± 0.35
11.11
iGHD (GH treated)
Lower than SGA-GHT
Lower than SGA-GHT
Higher than SGA-GHT
5.25 ± 0.25
1.59
Obesity
Comparable to SGA-GHT
Comparable to SGA-GHT
Comparable to SGA-GHT
Not specified
3.13
Lean Controls
Lowest
Lowest
Highest
5.09 ± 0.27
Not specified
SGA-GHT (Post GH therapy)
Elevated vs controls and iGHD
Elevated vs controls and iGHD
Not specified
Not specified
4.65
Key Findings
SGA children without catch-up growth treated with GH show significantly higher insulin resistance than children with isolated GH deficiency.
Insulin resistance levels in GH-treated SGA children approach those observed in children with obesity.
HbA1c levels are elevated in both GH-treated SGA and iGHD children compared to lean controls.
Prediabetes prevalence is highest in GH-treated SGA children (11.11%) compared to iGHD (1.59%) and obesity (3.13%) groups.
After cessation of GH therapy, SGA children retain elevated markers of prediabetes and insulin resistance similar to obese children.
No cases of overt type 2 diabetes were observed in any group during the study period.
Clinical Implications
Clinicians should be aware that GH therapy in SGA children may worsen insulin resistance and increase prediabetes risk, necessitating close metabolic monitoring during and after treatment. Early identification of impaired glucose metabolism can guide timely interventions to mitigate long-term metabolic complications. Comparing GH-treated SGA patients to obese children highlights the need for integrated metabolic risk management in this population.
Conclusion
SGA children treated with GH exhibit glucose-insulin metabolic impairments similar to those seen in obesity, which worsen under GH therapy and persist after treatment cessation. These findings underscore the importance of vigilant metabolic surveillance in GH-treated SGA patients.
References
European Medicines Agency 2003 -- Approval of GH treatment for SGA children
Study Authors 2024 -- Growth Hormone Treatment in Children Born Small for Gestational Age Affects Glucose-Insulin Metabolism Similar to Obesity-Related Impairments
