HOMA-IR in acromegaly: a systematic review and meta-analysis
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HOMA‑IR in acromegaly: a systematic review and meta‑analysis Betina Biagetti1 · Anna Aulinas2,3,4 · Anna Casteras1 · Santiago Pérez‑Hoyos5 · Rafael Simó1 Accepted: 1 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This review is aimed at examining whether the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is higher in Caucasian, adult, treatment-naïve patients with acromegaly (ACRO) than in the reference population independently of diabetes presence and to evaluate the impact of treatment [surgery and somatostatin analogues (SSAs)] on its assessment. Methods We systematically reviewed in PubMed and Web of Science from July 1985 to December 2019, registered with the code number CRD42020148737. The inclusion criteria comprised studies conducted in Caucasian adult treatment-naïve patients with active ACRO in whom HOMA-IR or basal insulin and glucose were reported. Three reviewers screened eligible publications, extracted the outcomes, and assessed the risk of biases. Results Of 118 originally selected studies, 15 met the inclusion criteria. HOMA-IR was higher in ACRO than the reference population, with mean difference and (95% confidence intervals) of 2.04 (0.65–3.44), even in ACRO patients without diabetes, 1.89 (1.06–2.73). HOMA-IR significantly decreased after treatment with either surgery or SSAs − 2.53 (− 3.24– − 1.81) and − 2.30 (− 3.05– − 1.56); respectively. However, the reduction of HOMA-IR due to SSAs did not improve basal glucose. Conclusion HOMA-IR in treatment-naïve ACRO patients is higher than in the reference population, even in patients without diabetes. This finding, confirms that insulin resistance is an early event in ACRO. Our results also suggest that HOMA-IR is not an adequate tool for assessing insulin resistance in those patients treated with SSAs. Keywords HOMA · Insulin resistance · Diabetes mellitus · Acromegaly · Meta-analysis
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11102-020-01092-6) contains supplementary material, which is available to authorized users. * Rafael Simó [email protected] Betina Biagetti [email protected] 1
Diabetes and Metabolism Research Unit, Vall D’Hebron Research Institute and CIBERDEM (ISCIII), Universidad Autónoma de Barcelona, Barcelona, Spain
2
Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau and Sant Pau–Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
3
Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERERUnidad 747), ISCIII, Barcelona, Spain
4
Faculty of Medicine, University of Vic Central University of Catalonia (UVic/UCC), Vic, Spain
5
Genetics Microbiology and Statistics Department, Statistics and Bioinformatics Unit, Vall D’Hebron Research Institute, Universitat de Barcelona, Barcelona, Spain
The homeostasis model assessment of insulin resistance (HOMA-IR) is classically consider a good
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