INSULIN-LIKE GROWTH FACTOR-I THERAPY IN DIABETES - PHYSIOLOGICAL-BASIS, CLINICAL BENEFITS, AND RISKS

Purpose: To review the effects of insulin-like growth factor-1 (IGF-1) and to discuss the clinical benefits and risks of using it in patient s with diabetes.Data Sources: Recent publications identified through a MEDLINE search using relevant keywords. Study Selection: Selected stu dies on the metabolic effects and kinetic mechanisms of in vitro IGF-1 and existing literature on the effects of IGF-1 on glucose and lipid metabolism in vivo with special emphasis on data from humans. Data Syn thesis: The substantial stimulatory effect of IGF-1 on glucose uptake suggests that, in selected clinical situations, the drug may be an alt ernative to standard treatment of diabetes. Metabolic control in patie nts with extreme insulin resistance is improved after using IGF-1. Mor eover, patients with type II (non-insulin-dependent) diabetes who rece ive IGF-1 have improved glucose tolerance and decreased hyperinsulinem ia and hypertriglyceridemia. The complications associated with long-te rm administration of IGF-1 are unknown but might include the progressi on of certain neoplasms and diabetic complications, such as nephropath y and retinopathy. Conclusions: Insulin-like growth factor-1 may be a useful adjunct for treatment of diabetes and may even be the drug of c hoice in some patients with extreme insulin resistance who have metabo lic emergencies. However, further data are needed to evaluate the risk s and benefits of IGF-1 use in diabetes and in other states associated with impaired insulin action.