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Observational Study
. 2022 Aug 18;107(9):2483-2492.
doi: 10.1210/clinem/dgac400.

Effect of Diabetes on Morbidity and Mortality in Patients With Acromegaly

Daniela Esposito  1   2 , Daniel S Olsson  1   2 , Stefan Franzén  3 , Mervete Miftaraj  4 , Jonatan Nåtman  4 , Soffia Gudbjörnsdottir  4   5 , Gudmundur Johannsson  1   2
Affiliations
Observational Study

Effect of Diabetes on Morbidity and Mortality in Patients With Acromegaly

Daniela Esposito et al. J Clin Endocrinol Metab. .

Abstract

Context: Diabetes is a major risk factor for cardiovascular disease and death but its effect on outcomes in acromegaly is unknown.

Objective: This work aimed to study whether diabetes affects morbidity and mortality in patients with acromegaly.

Methods: A nationwide (Sweden), observational, matched-cohort study was conducted. Patients diagnosed with acromegaly between 1987 and 2020 were identified in the Swedish National Patient Registry and those with concomitant type 2 diabetes in the National Diabetes Registry and Drug Registry. The risk of overall mortality, and cardiovascular mortality and morbidity were estimated using Cox regression.

Results: The study included 254 patients with acromegaly and concomitant type 2 diabetes (ACRO-DM group) and 532 without diabetes (ACRO group). Mean (SD) age at baseline was 62.6 (11.4) and 60.0 (12.1) years (P = .004) and the mean (SD) duration of acromegaly was 6.8 (8.1) and 6.0 (6.2) years (P = .098) in the ACRO-DM and ACRO groups, respectively. Overall mean follow-up was 9.2 years. The unadjusted overall mortality rate per 1000 person-years was 35.1 (95% CI, 27.2-44.7) and 20.1 (95% CI, 16.5-24.3) in the respective groups. The hazard ratio (HR) for overall mortality adjusted for multiple confounders was 1.58 (95% CI, 1.12-2.23) in the ACRO-DM group compared with the ACRO group. Cardiovascular mortality (HR 2.11; 95% CI, 1.09-4.10) and morbidity (HR 1.49; 95% CI, 1.21-1.82) were also increased in the ACRO-DM group.

Conclusion: The presence of diabetes in patients with acromegaly was associated with increased overall mortality as well as increased cardiovascular mortality and morbidity.

Keywords: acromegaly; cardiovascular morbidity; diabetes; mortality.

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Figures

Figure 1.
Figure 1.
Hazard ratios for overall mortality, and cardiovascular (CV) mortality and morbidity. Unadjusted and fully adjusted using propensity score hazard ratios in patients with acromegaly and type 2 diabetes compared with patients with acromegaly without diabetes.
Figure 2.
Figure 2.
Kaplan-Meier plots for all-cause mortality. A, Unadjusted, and B, fully propensity score–adjusted plots in patients with acromegaly and type 2 diabetes compared with patients with acromegaly without diabetes.
Figure 3.
Figure 3.
Kaplan-Meier plots for cardiovascular morbidity. A, Unadjusted, and B, fully propensity score–adjusted plots in patients with acromegaly and type 2 diabetes compared with patients with acromegaly without diabetes. CVD, cardiovascular disease.
See this image and copyright information in PMC

References

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