Insulin Sensitivity Decreases in Short Children Born Small for Gestational Age Treated with Growth Hormone

Objectives To evaluate insulin sensitivity in short children born small for gestational age (SGA) treated with growth hormone (GH). and to study the relationship between growth response and insulin levels. Study design In 29 children (16 female, 13 male) who were short and SGA. an oral glucose tolerance test was performed before (mean age. 8.8 years: range. 4.5-14.3 years) and after 1 year of GH treatment (33 mu g/kg/day). Insulin sensitivity was calculated with the homeostasis model assessment (HOMA) and the insulin sensitivity index (ISI) of Matsuda. Results The mean height increased from -3.1 to -2.4 SD. Insulin resistance (ISI <5) was seen in 17.2% of children before and in 48.3% (mainly, pubertal) children after GH treatment. Insulin sensitivity decreased significantly: ISI fell front 12.2 to 6.1 (P = .02) and HOMA increased from 1.2 to 2.2 (P = .001). Glucose and HbA1c levels did not change significantly. ISI after 1 year did not correlate with height gain. but it did correlate with age (r = -0.469, P = .01) and body mass index (r = -0.52. P = .004). Conclusions Insulin sensitivity is impaired in some children who are SGA already at baseline and decreases with GH treatment in most of them. Children close to puberty and children who are less underweight have the highest risk to become insulin resistant. (J Pediatr 2009:154:509-13)