Abstract
OBJECTIVES: Although evidence suggests that the overall prevalence of type 2 diabetes mellitus (T2DM) was already higher in the acromegaly group than in the general population several years before diagnosis, the effect of glycaemic status on the risk of developing acromegaly remains unclear. DESIGN: Retrospective cohort study. SETTING: Data were obtained from the National Health Insurance Services in Korea. Baseline glycaemic status was defined based on fasting plasma glucose levels and prescription records, and it was classified into three categories: normal fasting glucose (NFG), impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM) or five categories: NFG, IFG, new-onset T2DM, well-controlled T2DM and poorly controlled T2DM. PARTICIPANTS: A total of 9 707 487 adults without acromegaly participated in the national health screening programme in 2009 and were followed up until 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: The main outcome of interest was the diagnosis of incident acromegaly. RESULTS: Over a median follow-up period of 9.2 years, 434 people (4.5 cases per 100 000 people) developed acromegaly at least 1 year after enrolment. Participants with IFG and T2DM exhibited an increased risk of acromegaly, with hazard ratios (HR) of 2.27 (95% CI 1.84 to 2.80) and 2.45 (95% CI 1.78 to 3.39), respectively, compared with those with NFG. When participants were categorised into five glycaemic status groups, an increased risk of acromegaly was observed in those with new-onset T2DM (HR 2.18, 95% CI 1.38 to 3.43) and well-controlled T2DM (HR 2.29, 95% CI 1.28 to 4.09), similar to individuals with IFG, with the highest risk found in individuals with poorly controlled T2DM (HR 3.07, 95% CI 1.88 to 5.01). These associations are persistent across various subgroups, regardless of age, sex, lifestyle factors and the presence of comorbidities. CONCLUSIONS: The results of this study supported that alterations in glucose metabolism, including IFG and T2DM, are associated with an increased risk of acromegaly.