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Risks and Benefits of Insulin-like Growth Factor
- Bartolome Burguera, MD, PhD
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TO THE EDITOR:
The recent National Institutes of Health (NIH) conference [1] clearly and elegantly outlines the current understanding of the therapeutic use of IGF-I on growth deficits and diabetes.
I was surprised, however, by the negative views on the potential use of IGF-I as an alternative to insulin in patients with extreme insulin resistance. Dr. Skarulis extensively discussed two abstracts: 1) a study of five patients in whom IGF-I did not increase the glucose infusion required to maintain euglycemic levels during an IGF-I infusion and 2) IGF-I treatment in a patient with the Rabson-Mendenhall syndrome who did not achieve glycemic control. However, three peer-reviewed articles show a dramatic effect of short-term (hours) or long-term (months) IGF-I treatment, which achieved improved glycemic control in patients with extreme insulin resistance [2-4]. In addition, Usala and colleagues [4] reported reversal of life-threatening, insulin-resistant diabetes ketoacidosis with IGF-I treatment.
I agree with Dr. Skarulis that the dose, the route of administration, and especially the circulating levels of IGF-binding proteins could explain the differences between her interesting data and the previous published reports. Further studies evaluating the role of the specific receptor responsible for IGF-I hypoglycemic action[5] and the long-term secondary effects of IGF-I treatment in these patients are necessary. Although not all patients with insulin resistance seem to benefit from IGF-I treatment, it should be noted that IGF-I therapy may play an important role in treating patients with severe insulin resistance.
Bartolome Burguera, MD, PhD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
