{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:50:26Z","timestamp":1765824626492,"version":"3.48.0"},"reference-count":38,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,1,21]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 9\u2009707\u2009487 adults without acromegaly participated in the national health screening programme in 2009 and were followed up until 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The main outcome of interest was the diagnosis of incident acromegaly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a median follow-up period of 9.2 years, 434 people (4.5 cases per 100\u2009000 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%\u2009CI 1.38 to 3.43) and well-controlled T2DM (HR 2.29, 95%\u2009CI 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%\u2009CI 1.88 to 5.01). These associations are persistent across various subgroups, regardless of age, sex, lifestyle factors and the presence of comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this study supported that alterations in glucose metabolism, including IFG and T2DM, are associated with an increased risk of acromegaly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087884","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T04:18:13Z","timestamp":1742530693000},"page":"e087884","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association between glycaemic status and the risk of acromegaly: a nationwide population-based cohort study"],"prefix":"10.1136","volume":"15","author":[{"given":"Eun","family":"Roh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, South Korea"},{"name":"Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji Hye","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Na","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2174-9726","authenticated-orcid":false,"given":"Kyung Do","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University College of Natural Sciences, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9523-7251","authenticated-orcid":false,"given":"Jun Goo","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong Jin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sung-Hee","family":"Ihm","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"2025121510402898000_15.3.e087884.1","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/S2213-8587(22)00244-3","article-title":"Acromegaly: pathogenesis, diagnosis, and management","volume":"10","author":"Fleseriu","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025121510402898000_15.3.e087884.2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-16-0117"},{"key":"2025121510402898000_15.3.e087884.3","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s11102-013-0471-7","article-title":"Prevalence and risk factors of impaired glucose tolerance and diabetes mellitus at diagnosis of acromegaly: a study in 148 patients","volume":"17","author":"Alexopoulou","year":"2014","journal-title":"Pituitary"},{"key":"2025121510402898000_15.3.e087884.4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-031199"},{"key":"2025121510402898000_15.3.e087884.5","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1038\/s41574-024-00993-x","article-title":"Diabetes mellitus in patients with acromegaly: pathophysiology, clinical challenges and management","volume":"20","author":"Esposito","year":"2024","journal-title":"Nat Rev Endocrinol"},{"key":"2025121510402898000_15.3.e087884.6","first-page":"E835","article-title":"Demonstration of a role for growth hormone in glucose counterregulation","volume":"256","author":"De Feo","year":"1989","journal-title":"Am J Physiol"},{"key":"2025121510402898000_15.3.e087884.7","doi-asserted-by":"publisher","DOI":"10.1038\/S41574-019-0280-9"},{"key":"2025121510402898000_15.3.e087884.8","doi-asserted-by":"publisher","DOI":"10.1210\/er.2008-0027"},{"key":"2025121510402898000_15.3.e087884.9","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.50.10.2301"},{"key":"2025121510402898000_15.3.e087884.10","doi-asserted-by":"publisher","DOI":"10.1210\/er.2018-00115"},{"key":"2025121510402898000_15.3.e087884.11","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-017-0797-7"},{"key":"2025121510402898000_15.3.e087884.12","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1093\/eurheartj\/ehab822","article-title":"Acromegaly and cardiovascular outcomes: a cohort study","volume":"43","author":"Hong","year":"2022","journal-title":"Eur Heart J"},{"key":"2025121510402898000_15.3.e087884.13","doi-asserted-by":"crossref","first-page":"2483","DOI":"10.1210\/clinem\/dgac400","article-title":"Effect of Diabetes on Morbidity and Mortality in Patients With Acromegaly","volume":"107","author":"Esposito","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"2025121510402898000_15.3.e087884.14","doi-asserted-by":"crossref","DOI":"10.1210\/clinem\/dgz317","article-title":"Risk for Acromegaly-related Comorbidities by Sex in Korean Acromegaly","volume":"105","author":"Park","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"2025121510402898000_15.3.e087884.15","article-title":"Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea","volume":"46","author":"Lee","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2025121510402898000_15.3.e087884.16","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2014.38.5.395"},{"key":"2025121510402898000_15.3.e087884.17","doi-asserted-by":"crossref","DOI":"10.1186\/s13023-019-1032-6","article-title":"The cumulative incidence and trends of rare diseases in South Korea: a nationwide study of the administrative data from the National Health Insurance Service database from 2011-2015","volume":"14","author":"Lim","year":"2019","journal-title":"Orphanet J Rare Dis"},{"key":"2025121510402898000_15.3.e087884.18","doi-asserted-by":"crossref","first-page":"10","DOI":"10.3803\/EnM.2023.102","article-title":"Big Data Research in the Field of Endocrine Diseases Using the Korean National Health Information Database","volume":"38","author":"Cho","year":"2023","journal-title":"Endocrinol Metab (Seoul)"},{"key":"2025121510402898000_15.3.e087884.19","first-page":"e1875","article-title":"Risk of Neurodegenerative Diseases in Patients With Acromegaly: A Cohort Study","volume":"99","author":"Hong","year":"2022","journal-title":"Neurology (ECronicon)"},{"key":"2025121510402898000_15.3.e087884.20","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-1550"},{"key":"2025121510402898000_15.3.e087884.21","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-S002"},{"key":"2025121510402898000_15.3.e087884.22","doi-asserted-by":"publisher","DOI":"10.2337\/DC23-S006"},{"key":"2025121510402898000_15.3.e087884.23","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.3346\/jkms.2015.30.9.1266","article-title":"Treatment Gap in the National Health-screening Program in Korea: Claim-based Follow-up of Statin Use for Sustained Hypercholesterolemia","volume":"30","author":"Ahn","year":"2015","journal-title":"J Korean Med Sci"},{"key":"2025121510402898000_15.3.e087884.24","doi-asserted-by":"crossref","first-page":"209","DOI":"10.4093\/dmj.2019.0223","article-title":"Effect of Sarcopenia and Body Shape on Cardiovascular Disease According to Obesity Phenotypes","volume":"45","author":"Cho","year":"2021","journal-title":"Diabetes Metab J"},{"key":"2025121510402898000_15.3.e087884.25","doi-asserted-by":"crossref","first-page":"552","DOI":"10.4093\/dmj.2022.0193","article-title":"Current Trends of Big Data Research Using the Korean National Health Information Database","volume":"46","author":"Kim","year":"2022","journal-title":"Diabetes Metab J"},{"key":"2025121510402898000_15.3.e087884.26","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0215687","article-title":"Total cholesterol variability and risk of atrial fibrillation: A nationwide population-based cohort study","volume":"14","author":"Roh","year":"2019","journal-title":"PLoS One"},{"key":"2025121510402898000_15.3.e087884.27","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2021.044"},{"key":"2025121510402898000_15.3.e087884.28","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2017.428"},{"key":"2025121510402898000_15.3.e087884.29","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.tem.2016.04.014","article-title":"Current and Emerging Aspects of Diabetes Mellitus in Acromegaly","volume":"27","author":"Frara","year":"2016","journal-title":"Trends Endocrinol Metab"},{"key":"2025121510402898000_15.3.e087884.30","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2000.00986.x"},{"key":"2025121510402898000_15.3.e087884.31","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-010-0284-x"},{"key":"2025121510402898000_15.3.e087884.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12902-017-0166-6","article-title":"The association between biochemical control and cardiovascular risk factors in acromegaly","volume":"17","author":"Carmichael","year":"2017","journal-title":"BMC Endocr Disord"},{"key":"2025121510402898000_15.3.e087884.33","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-0084"},{"key":"2025121510402898000_15.3.e087884.34","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2018.00358","article-title":"Diabetes Secondary to Acromegaly: Physiopathology, Clinical Features and Effects of Treatment","volume":"9","author":"Ferra\u00f9","year":"2018","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2025121510402898000_15.3.e087884.35","doi-asserted-by":"publisher","DOI":"10.1186\/2042-6410-3-13"},{"key":"2025121510402898000_15.3.e087884.36","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-2896"},{"key":"2025121510402898000_15.3.e087884.37","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-10-1050"},{"key":"2025121510402898000_15.3.e087884.38","doi-asserted-by":"crossref","first-page":"2369","DOI":"10.1210\/jc.2018-00325","article-title":"Persistence of Diabetes and Hypertension After Multimodal Treatment of Acromegaly","volume":"103","author":"Gonz\u00e1lez","year":"2018","journal-title":"J Clin Endocrinol Metab"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-087884","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:40:40Z","timestamp":1765824040000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-087884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,18]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bmjopen-2024-087884"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-087884","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}