Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement
Pasireotide is a somatostatin analogue for the treatment of acromegaly, a chronic condition caused by excess growth hormone. Despite the therapeutic benefits of pasireotide as a second-line treatment for inadequately controlled acromegaly, a major concern is its hyperglycemic side-effect. Here, we p...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2024.1348990/full |
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| author | Sylvère Störmann Sebastian M. Meyhöfer Sebastian M. Meyhöfer Jan B. Groener Johanna Faust Katharina Schilbach Jochen Seufert Bruno Vergès Bruno Vergès |
| author_facet | Sylvère Störmann Sebastian M. Meyhöfer Sebastian M. Meyhöfer Jan B. Groener Johanna Faust Katharina Schilbach Jochen Seufert Bruno Vergès Bruno Vergès |
| author_sort | Sylvère Störmann |
| collection | DOAJ |
| description | Pasireotide is a somatostatin analogue for the treatment of acromegaly, a chronic condition caused by excess growth hormone. Despite the therapeutic benefits of pasireotide as a second-line treatment for inadequately controlled acromegaly, a major concern is its hyperglycemic side-effect. Here, we provide guidance on how to select appropriate patients with acromegaly for treatment with pasireotide. We summarize baseline characteristics of patients at high risk for pasireotide-associated hyperglycemia and recommend a monitoring strategy based on the risk profile. Self-monitoring of blood glucose levels (SMBG), measurements of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and regular HbA1c measurements are the foundation of our proposed monitoring approach. The pathophysiology of pasireotide-induced hyperglycemia involves decreased secretion of the incretin hormones GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1). Our expert recommendations address the specific pathophysiology of pasireotide-induced hyperglycemia by recommending the incretin-based therapeutics dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in all appropriate patients as an alternative to first-line monotherapy with metformin. Furthermore, we emphasize the importance of adequate control of acromegaly, excellent diabetes education, nutrition and lifestyle guidance and advise to consult expert diabetologists in case of uncertainty in the management of patients with hyperglycemia under pasireotide. |
| first_indexed | 2024-03-08T04:06:18Z |
| format | Article |
| id | doaj.art-1a733fabc6b64ae283d2a2947f875444 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-08T04:06:18Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-1a733fabc6b64ae283d2a2947f8754442024-02-09T05:03:38ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922024-02-011510.3389/fendo.2024.13489901348990Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statementSylvère Störmann0Sebastian M. Meyhöfer1Sebastian M. Meyhöfer2Jan B. Groener3Johanna Faust4Katharina Schilbach5Jochen Seufert6Bruno Vergès7Bruno Vergès8Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, GermanyInstitute for Endocrinology & Diabetes, University of Lübeck, Lübeck, GermanyGerman Centre for Diabetes Research (DZD), Munich-Neuherberg, GermanyZentrum für Diabetes und Hormonerkrankungen Neustadt, Neustadt, GermanyMedicover Neuroendocrinology, Munich, GermanyMedizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, GermanyKlinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, GermanyEndocrinology Diabetics and Metabolic Disorders Department, Dijon University Hospital, Dijon, FranceFrench National Health and Medical Research Body Unit, Lipid-Nutrition-Cancer-1231, University of Burgundy, Dijon, FrancePasireotide is a somatostatin analogue for the treatment of acromegaly, a chronic condition caused by excess growth hormone. Despite the therapeutic benefits of pasireotide as a second-line treatment for inadequately controlled acromegaly, a major concern is its hyperglycemic side-effect. Here, we provide guidance on how to select appropriate patients with acromegaly for treatment with pasireotide. We summarize baseline characteristics of patients at high risk for pasireotide-associated hyperglycemia and recommend a monitoring strategy based on the risk profile. Self-monitoring of blood glucose levels (SMBG), measurements of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and regular HbA1c measurements are the foundation of our proposed monitoring approach. The pathophysiology of pasireotide-induced hyperglycemia involves decreased secretion of the incretin hormones GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1). Our expert recommendations address the specific pathophysiology of pasireotide-induced hyperglycemia by recommending the incretin-based therapeutics dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in all appropriate patients as an alternative to first-line monotherapy with metformin. Furthermore, we emphasize the importance of adequate control of acromegaly, excellent diabetes education, nutrition and lifestyle guidance and advise to consult expert diabetologists in case of uncertainty in the management of patients with hyperglycemia under pasireotide.https://www.frontiersin.org/articles/10.3389/fendo.2024.1348990/fullacromegalypasireotidehyperglycemiadiabetes mellitusmonitoring strategypatient management |
| spellingShingle | Sylvère Störmann Sebastian M. Meyhöfer Sebastian M. Meyhöfer Jan B. Groener Johanna Faust Katharina Schilbach Jochen Seufert Bruno Vergès Bruno Vergès Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement Frontiers in Endocrinology acromegaly pasireotide hyperglycemia diabetes mellitus monitoring strategy patient management |
| title | Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement |
| title_full | Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement |
| title_fullStr | Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement |
| title_full_unstemmed | Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement |
| title_short | Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts’ consensus statement |
| title_sort | management of pasireotide induced hyperglycemia in patients with acromegaly an experts consensus statement |
| topic | acromegaly pasireotide hyperglycemia diabetes mellitus monitoring strategy patient management |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2024.1348990/full |
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