IGF1 and diabetes mellitus: While it is widely accepted that we need new diagnostic strategies to reduce the gap between symptom initiation and diagnosis, studies that evaluated the benefits of screening using IGF-1, especially among patients with acromegaly associated comorbidities (such as sleep apnea, diabetes, or hypertension), deemed screening for acromegaly as cost-ineffective, possibly due to the low prevalence of acromegaly in the general population [71,72].