Daily growth hormone (LAGH) is a hormone produced by the pancreas that helps improve the body’s ability to burn fat. It is also an important part of the body’s immune system, which protects the body from harmful bacteria and viruses. LAGH is used to treat a number of conditions, including diabetes, obesity, depression, and many other types of chronic diseases. However, there are certain side effects associated with this hormone, so it’s important to know them before taking it.
Analyses of serum GH and IGF1
IGF1 is an insulin-like growth factor that is derived from the GH and plays an important role in the regulation of GH. It is also known to have an anabolic effect. The primary mechanism for the production of IGF-1 is stimulation of GH by exogenous GH.
Recently, a meta-analysis was performed that reviewed studies that used immunoradiometric or RIA assays to measure serum IGFI. Sensitivity and specificity were highly variable in these studies. Some studies reported sensitivities of 85% to 100%, while others reported CVs of less than 7.0%. Nonetheless, a positive Z-score indicates an elevated IGF-1 level.
Several studies have evaluated the role of serum IGF1 in diagnosing GHD. These studies have included various study populations. While some of the studies incorporated a large number of participants, other studies only used a small sample size. This is an inherent limitation of retrospective studies. In addition, heterogeneity among studies was estimated using the Cochran Q test.
Studies that investigated the association between circulating IGF1 and mortality were found to have a U-shaped relationship. The sensitivity and specificity of serum IGF1 was high in a few studies, while they were low in others. There was a significant positive correlation between mortality and IGF-1, supporting the hypothesis that IGF-1 might play a crucial role in the development of COVID-19-related ARDS.
A large cohort of children with short stature was studied. This study was the first to use the same assay to detect serum GH and IGF1 for acromegaly. Moreover, the study was conducted in real clinical settings.
Subjects were subdivided into four groups based on age. Non-GHD subjects were defined as those with a GH peak of
In order to determine the optimal cut-off for the IGF1 SDS, ROC analysis was performed. IGF1 SDS (Z-score) was calculated as log IGF1 ng/L – log mean for age. The value was then calculated for all studies, including those with overlap.
As an additional measure of the accuracy of the test, the area under the curve was analyzed. A p-value of 0.05 was considered statistically significant.
Adherence to LAGH
Adherence to daily growth hormone (GH) is a challenge in pediatric growth hormone deficiency (GHD) treatment. The goal is to maximize the effectiveness of treatment through adherence. Several studies have evaluated the relationship between adherence and growth outcomes. Among these, a study from Spain, using a questionnaire-based adherence survey, reported a 90.2% adherence rate.
Another study, a national survey of GH compliance, included 177 children in New Zealand. In that study, non-adherence was associated with lower predicted height velocities. However, the percentage of days covered did not seem to be a good measure of adherence. Compared to the full weekly protocol, the same dose administered every six days seemed to be more tolerable.
Adherence to r-hGH is a challenge, and low adherence is a factor in reduced growth gain. It is unclear how the inverse relationship between adherence and treatment efficacy works. Despite the complexity of the issue, a new device that aims to improve adherence is on the horizon.
A multicenter observational study of 824 children with GHD treated with r-hGH for 3 months showed that poor adherence was associated with reduced growth gain. Non-adherent patients had significantly lower predicted height velocities than adherent patients.
However, adherence was not measured in the same way as the quality of life measure. The main clinical challenge is inability to accurately assess adherence. Efforts to improve adherence include the use of improved devices and appropriate training.
A more comprehensive assessment of adherence would include more items. For example, a survey of adherence using a mobile app and questionnaires, as well as a nifty device. Among the most important adherence indicators are the length of time a patient is able to comply with their medication schedule.
The most interesting aspect of the study was its ability to test the theory of reducing the total number of injections by switching from a weekly protocol to a single daily lonapegsomatropin injection. Although this is an exciting research area, it is not yet known if reduced injection frequency is an effective method to improve adherence.
Sleep apnea and/or hyperglycemia
If you’re a diabetic, you probably know that hyperglycemia is a known risk factor for cardiovascular disease. However, the relationship between sleep apnea and hyperglycemia remains a matter of conjecture. As a result, more studies are needed to determine whether the two are compatible.
One of the simplest ways to test this hypothesis is by evaluating blood glucose levels during sleep in OSA patients with normal glucose tolerance. While past studies have examined the relationship between GV and AHI in diabetic patients with OSA, a few have investigated the actual number of GV and other glycemic metrics during sleep. The CPAP-treated group showed a marked improvement in a variety of metrics. In particular, the glyceremic titration and the heart rate of the night improved significantly. This may be attributed to the fact that a sleep mask with air pressure augmentation increases the airflow in the throat and nasal passages.
Another study, reported by Bialasiewicz et al., found that a brief pause in breathing at night was associated with an early morning decrease in blood glucose levels. Using a flash glucose monitoring device, the researchers evaluated a series of blood glucose readings over the course of 14 days. Several indexes were notably improved after a seven-day CPAP regimen.
A small sample of OSA and non-OSA participants with a history of type 2 diabetes were tested in the same study. The best results were obtained by using a flash glucose monitoring device to record glucose readings throughout the night. The study found that, while sleep apnea was not a risk factor for type 2 diabetes, the presence of the disease significantly increased the risk of sleep-related hypoglycemia. Specifically, the highest blood glucose readings were recorded while a patient was attempting to fall asleep or during periods of non-REM sleep.
Lastly, a multidisciplinary team of experts should be consulted to devise an effective protocol for determining the risk factors and addressing them. The result is a reduction in morbidity and mortality, as well as a happier patient. Interestingly, the benefits of a CPAP treatment were not limited to sleep; it also improved hemodynamic parameters in a number of other OSA patients.