Background: Acromegaly is an uncommon, chronic, debilitating condition characterized by hyperinsulinism, insulin resistance, diabetes and prediabetes. One possibility for managing acromegaly's questionable influence on glucose homeostasis is the somatostatin analogues. Aim: To analyze the frequency and risk factors for impaired glucose homeostasis in acromegaly patients treated with depot long-acting octreotide (octreotide LAR), as well as the relationship between risk and treatment duration. Methods: The study included 52 Iraqi adults with acromegaly receiving octreotide LAR. Demographic, anthropometric, and clinical data were collected, as well as the duration of Octreotide LAR administration. Growth hormone, IGF-1, and adenoma size were reported retrospectively from patient data. The glycemic state was assessed and classified as DM, prediabetes, or normal. Results: The prevalence of DM was 39% and prediabetes was 40%, with the exception of being male, which was substantially related with prediabetes. DM and octreotide LAR use had a non-significant correlation. However, octreotide use altered 13% of patients from normal glycemic to prediabetes, with no correlation to treatment duration. Other than hypertension and a family history of diabetes, no other variables were found to be significant. Conclusion: Acromegaly patients have abnormal glucose metabolism, which is associated with prediabetes owing to octreotide LAR medication. Hypertension and family history of diabetes are risk factors.