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Chowdhury AS, Palui R, Pramanik S, Mondal S. Glycemic variability in chronic calcific pancreatitis with diabetes mellitus and its possible determinants. Diabetes Metab Syndr 2024; 18:103100. [PMID: 39142092 DOI: 10.1016/j.dsx.2024.103100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
AIMS To study glycemic patterns and variability in patients with pancreatic diabetes or type 3c Diabetes mellitus (DM) due to chronic pancreatitis and its subtypes and assess the role of pancreatic enzyme replacement therapy (ERT) in modulating glycemic variability. METHODS Patients having type 3c DM due to chronic pancreatitis, and on insulin underwent Flash continuous-glucose-monitoring (CGM) for 14 days. Parameters were compared between patients with fibrocalculous pancreatic diabetes (FCPD) and non-FCPD-chronic calcific pancreatitis (non-FCPD) and between the recipients and non-recipients of pancreatic enzyme-replacement-therapy (ERT). RESULTS Out of 54 patients with pancreatic diabetes, 35 patients had chronic calcific pancreatitis. They underwent CGM, median HbA1c 9.20 % (77 mmol/mol) and mean Time-In-Range (TIR) being 41.21 % (23.48). Only 5 (15.2 %) patients achieved target TIR>70 % while 16 (48.5 %) patients had high glycemic-variability [Coefficient-of-variation (CV) > 36 %]. Patients with FCPD (n = 14) had higher hypoglycemia-indices like Time-Below-Range (18.92 % vs 8.20 %; p = 0.03) and Low-Blood-Glucose-Index (18.14 % vs 6.04 %; p = 0.02) compared to non-FCPD (n = 21). HbA1c% and hyperglycemic excursions were similar in both groups. Recipients of ERT (n = 20) had lower glycemic-variability [Standard Deviation (SD) 52.15 % vs 68.14 % and CV 32.59 % vs 41.79 %, p < 0.05 for both) than non-recipients. ERT-recipients had no serious hypoglycemia within the 14 days. On subgroup analysis, lower glycemic-variability and hypoglycemia with ERT were seen only in FCPD but not in non-FCPD subgroup (50.13 vs 77.91, 30.09 vs 48.36 for SD and CV respectively, p < 0.05). CONCLUSION Patients with type 3c DM due to chronic pancreatitis have high frequency of hyperglycemic and hypoglycemic excursions, with those with FCPD having a particularly higher risk of hypoglycemia and glycemic-variability. Those receiving pancreatic ERT had lesser glycemic variability and hypoglycemia. The small sample size and lack of objective markers of documentation of exocrine pancreatic insufficiency like fecal elastase highlight the need for further larger studies in this field.
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Affiliation(s)
| | - Rajan Palui
- Department of Endocrinology, The Mission Hospital, Durgapur, West Bengal, India.
| | | | - Sunetra Mondal
- Department of Endocrinology and Metabolism, HealthWorld hospitals, Durgapur, India.
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Nichols N, Rubenstein RC, Kelly A, Vachhani JJ, Echaluse MV, Garinis AC. Clinical Observations in Patients With Cystic Fibrosis-Related Diabetes and Self-Reported Ototoxicity Symptoms. Am J Audiol 2023; 33:1-9. [PMID: 38016170 PMCID: PMC11001426 DOI: 10.1044/2023_aja-22-00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/18/2023] [Accepted: 10/06/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Persons with cystic fibrosis (PwCF) are at high risk for ototoxicity due to the routine use of intravenous aminoglycoside (IV-AG) antibiotics in respiratory infection management. Additionally, factors that contribute to ototoxicity-related symptom development and severity in PwCF are unknown. Given the increased risk of ototoxicity in people with diabetes, we explored the association between cystic fibrosis-related diabetes (CFRD) and self-reported ototoxicity symptoms (tinnitus and vestibular problems) in PwCF treated with aminoglycosides. METHOD PwCF (N = 39; 25 females, 14 males; Mage = 30.1 years, SD = 10.3) were recruited from the Cystic Fibrosis Care Center at Oregon Health & Science University. Patients completed the validated questionnaires to ascertain their experiences with ototoxicity-related symptoms of tinnitus and balance function. The diagnosis of CFRD, including oral glucose tolerance testing (OGTT), insulin treatment, hemoglobin A1c, and cumulative IV-AG treatment history, was obtained through a medical chart review. Participants were classified into three groups based on their medical diagnoses via OGTT: normal glucose tolerance (NGT; control; n = 16), abnormal glucose tolerance (AGT; n = 9), and CFRD (n = 14). Participants in each group were further classified based on survey outcomes for ototoxicity-related symptoms. RESULTS There was a trend toward a higher proportion of patients with CFRD reporting tinnitus compared to the AGT and NGT groups, but did not meet statistical significance (X2 = 2.24, p = .13). Approximately, 43% of patients with CFRD reported experiencing clinically significant tinnitus lasting > 3 min compared to 11% in the AGT group and 13% in the NGT group (X2 = 3.751, p = .05). Cumulative IV-AG exposure tended to be higher in CFRD compared to other groups. High balance function was generally reported in all groups. CONCLUSIONS Patients with CFRD have greater ototoxicity-related symptoms. Further investigation of the relationship between CF-related comorbidities and the risk of developing ototoxicity-related symptoms is warranted to improve the detection and management of ototoxicity in PwCF.
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Affiliation(s)
- Nicole Nichols
- Department of Otolaryngology, Oregon Health & Science University, Portland
| | - Ronald C. Rubenstein
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, St. Louis, MO
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA
| | - Jay J. Vachhani
- Department of Otolaryngology, Oregon Health & Science University, Portland
- VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR
| | - Ma Vida Echaluse
- Department of Otolaryngology, Oregon Health & Science University, Portland
| | - Angela Constance Garinis
- Department of Otolaryngology, Oregon Health & Science University, Portland
- VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR
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Pinzaru AD, Mihai CM, Chisnoiu T, Pantazi AC, Lupu VV, Kassim MAK, Lupu A, Grosan E, Al Jumaili AZN, Ion I, Stoleriu G, Ion I. Oxidative Stress Biomarkers in Cystic Fibrosis and Cystic Fibrosis-Related Diabetes in Children: A Literature Review. Biomedicines 2023; 11:2671. [PMID: 37893045 PMCID: PMC10604378 DOI: 10.3390/biomedicines11102671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The most common inherited condition that results in death, particularly in those of Caucasian heritage, is cystic fibrosis (CF). Of all the young adults diagnosed with cystic fibrosis, 20% will develop hyperglycemia as a complication, later classified as a disease associated with cystic fibrosis. Impaired insulin secretion and glucose intolerance represent the primary mechanisms associated with diabetes (type 1 or type 2) and cystic fibrosis. Oxidative stress represents the imbalance between oxygen-reactive species and antioxidant defense mechanisms. This pathogenic mechanism is vital in triggering other chronic diseases, including cystic fibrosis-related diabetes. It is essential to understand oxidative stress and the significant impact it has on CFRD. This way, therapies can be individually adjusted and tailored to each patient's needs. This review aims to understand the connection between CFRD and oxidative stress. As a subsidiary element, we analyzed the effects of glycemic balance on complications and their evolution over time, providing insights into their potential benefits in mitigating oxidative stress-associated complications.
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Affiliation(s)
- Anca Daniela Pinzaru
- Department of Pediatrics, Faculty of Medicine, “Ovidius” University, 900470 Constanta, Romania
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Cristina Maria Mihai
- Department of Pediatrics, Faculty of Medicine, “Ovidius” University, 900470 Constanta, Romania
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Tatiana Chisnoiu
- Department of Pediatrics, Faculty of Medicine, “Ovidius” University, 900470 Constanta, Romania
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | | | - Vasile Valeriu Lupu
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Ancuta Lupu
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Grosan
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Ahmed Zaki Naji Al Jumaili
- National Institute of Diabetes, Nutrition and Metabolic Diseases “N.C. Paulescu”, 020475 Bucharest, Romania
| | - Irina Ion
- Department of Pediatrics, Faculty of Medicine, “Ovidius” University, 900470 Constanta, Romania
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Gabriela Stoleriu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Ileana Ion
- Faculty of Medicine, “Ovidius” University, 900470 Constanta, Romania
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Ruhluel D, O'Brien S, Fothergill JL, Neill DR. Development of liquid culture media mimicking the conditions of sinuses and lungs in cystic fibrosis and health. F1000Res 2022; 11:1007. [PMID: 36519007 PMCID: PMC9718992 DOI: 10.12688/f1000research.125074.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/25/2023] Open
Abstract
The respiratory tract is a compartmentalised and heterogenous environment. The nasopharynx and sinuses of the upper airways have distinct properties from the lungs and these differences may shape bacterial adaptation and evolution. Upper airway niches act as early colonisation sites for respiratory bacterial pathogens, including those, such as Pseudomonas aeruginosa, that can go on to establish chronic infection of the lungs in people with cystic fibrosis (CF). Despite the importance of upper airway environments in facilitating early adaptation to host environments, currently available in vitro models for study of respiratory infection in CF focus exclusively on the lungs. Furthermore, animal models, widely used to bridge the gap between in vitro systems and the clinical scenario, do not allow the upper and lower airways to be studied in isolation. We have developed a suite of culture media reproducing key features of the upper and lower airways, for the study of bacterial adaptation and evolution in different respiratory environments. For both upper and lower airway-mimicking media, we have developed formulations that reflect airway conditions in health and those that reflect the altered environment of the CF respiratory tract. Here, we describe the development and validation of these media and their use for study of genetic and phenotypic adaptations in P. aeruginosa during growth under upper or lower airway conditions in health and in CF.
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Affiliation(s)
- Dilem Ruhluel
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences,, Liverpool, L69 7BE, UK
| | - Siobhan O'Brien
- Department of Microbiology, Moyne Institute of Preventive Medicine, Trinity College, Dublin, 2, Ireland
| | - Joanne L Fothergill
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences,, Liverpool, L69 7BE, UK
| | - Daniel R Neill
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences,, Liverpool, L69 7BE, UK
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Ruhluel D, O'Brien S, Fothergill JL, Neill DR. Development of liquid culture media mimicking the conditions of sinuses and lungs in cystic fibrosis and health. F1000Res 2022; 11:1007. [PMID: 36519007 PMCID: PMC9718992 DOI: 10.12688/f1000research.125074.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
The respiratory tract is a compartmentalised and heterogenous environment. The nasopharynx and sinuses of the upper airways have distinct properties from the lungs and these differences may shape bacterial adaptation and evolution. Upper airway niches act as early colonisation sites for respiratory bacterial pathogens, including those, such as Pseudomonas aeruginosa, that can go on to establish chronic infection of the lungs in people with cystic fibrosis (CF). Despite the importance of upper airway environments in facilitating early adaptation to host environments, currently available in vitro models for study of respiratory infection in CF focus exclusively on the lungs. Furthermore, animal models, widely used to bridge the gap between in vitro systems and the clinical scenario, do not allow the upper and lower airways to be studied in isolation. We have developed a suite of culture media reproducing key features of the upper and lower airways, for the study of bacterial adaptation and evolution in different respiratory environments. For both upper and lower airway-mimicking media, we have developed formulations that reflect airway conditions in health and those that reflect the altered environment of the CF respiratory tract. Here, we describe the development and validation of these media and their use for study of genetic and phenotypic adaptations in P. aeruginosa during growth under upper or lower airway conditions in health and in CF.
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Affiliation(s)
- Dilem Ruhluel
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences,, Liverpool, L69 7BE, UK
| | - Siobhan O'Brien
- Department of Microbiology, Moyne Institute of Preventive Medicine, Trinity College, Dublin, 2, Ireland
| | - Joanne L Fothergill
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences,, Liverpool, L69 7BE, UK
| | - Daniel R Neill
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences,, Liverpool, L69 7BE, UK
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Toner A, McCloy A, Dyce P, Nazareth D, Frost F. Continuous glucose monitoring systems for monitoring cystic fibrosis-related diabetes. Cochrane Database Syst Rev 2021; 11:CD013755. [PMID: 34844283 PMCID: PMC8629645 DOI: 10.1002/14651858.cd013755.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is one of the most common life-shortening autosomal-recessive genetic conditions with around 100,000 people affected globally. CF mainly affects the respiratory system, but cystic fibrosis-related diabetes (CFRD) is a common extrapulmonary co-morbidity and causes excess morbidity and mortality in this population. Continuous glucose monitoring systems (CGMS) are a relatively new technology and, as yet, the impact of these on the monitoring and subsequent management of CFRD remains undetermined. OBJECTIVES To establish the impact of insulin therapy guided by continuous glucose monitoring compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 23 September 2021. We also searched the reference lists of relevant articles and reviews and online trials registries. Date of last search: 23 September 2021. SELECTION CRITERIA Randomised controlled studies comparing insulin regimens led by data from CGMS (including real-time or retrospective data, or both) with insulin regimens guided by abnormal blood glucose measurements collected through other means of glycaemic data collection in people with CFRD. Studies with a cross-over design, even with a washout period between intervention arms, are not eligible for inclusion due to the potential long-term impact of each of the interventions and the potential to compromise the outcomes of the second intervention. DATA COLLECTION AND ANALYSIS No studies were included in the review, meaning that no data were available to be collected for analysis. MAIN RESULTS Review authors screened 14 studies at the full-text stage against the review's inclusion criteria. Consequently, seven were excluded due to the study type being ineligible (not randomised), two studies were excluded due to their cross-over design, and two studies was excluded since the intervention used was not eligible and one was a literature review. One study in participants hospitalised for a pulmonary exacerbation is ongoing. Investigators are comparing insulin dosing via insulin pump with blood sugar monitoring by a CGMS to conventional diabetes management with daily insulin injections (or on an insulin pump if already on an insulin pump in the outpatient setting) and capillary blood glucose monitoring. The participants in the control arm will wear a blinded continuous glucose monitoring system for outcome assessment. In addition to this, one further study is still awaiting classification, and will be screened to determine whether it is eligible for inclusion, or is to be excluded, in an update of this review. AUTHORS' CONCLUSIONS No studies were included in the review, indicating that there is currently insufficient evidence to determine the impact of insulin therapy guided by CGMS compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD, nor on potential adverse effects of continuous glucose monitoring in this context. Randomised controlled studies are needed to generate evidence on the efficacy and safety of continuous glucose monitoring in people with CFRD. There is one relevant ongoing study that may be eligible for inclusion in a future update of this Cochrane Review, and whose results may help answer the review question.
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Affiliation(s)
- Aileen Toner
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Anna McCloy
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Paula Dyce
- Cystic Fibrosis/Respiratory Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Dilip Nazareth
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Freddy Frost
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Frost F, Nazareth D, Shaw M, Walshaw MJ. Cystic fibrosis related diabetes is not independently associated with increased Stenotrophomonas maltophilia infection: Longitudinal data from the UK CF Registry. J Cyst Fibros 2019; 18:294-298. [PMID: 30741162 DOI: 10.1016/j.jcf.2018.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Stenotrophomonas maltophilia is common in the sputum of people with cystic fibrosis related diabetes (CFRD), raising the question as to whether this is a risk factor for its acquisition. We investigated this at a population level. METHODS We analysed national Cystic Fibrosis Registry data 2011-2015 for 8047 people with CF > age 6 years, looking at demographics, diagnosis of CFRD, lung function and sputum microbiology; using descriptive and multivariate strategies to establish independent predictors for S. maltophilia culture and associated outcomes. RESULTS S. maltophilia was present in 1148 (14.1%). Although univariate analysis confirmed it was more prevalent in those with CFRD, when adjusted for other clinical parameters there was no longer a relationship. Markers of more severe lung disease were independent risk-factors for S. maltophilia. CONCLUSION Although S. maltophilia is more common in people with CFRD, it is not an independent risk-factor for S. maltophilia acquisition.
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Affiliation(s)
- Freddy Frost
- Adult Cystic Fibrosis Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
| | - Dilip Nazareth
- Adult Cystic Fibrosis Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
| | - Matthew Shaw
- Research Department, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
| | - Martin J Walshaw
- Adult Cystic Fibrosis Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
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Diabetes mellitus Typ 3c – Prävalenz, Diagnose, Besonderheiten der Therapie. DIABETOLOGE 2018. [DOI: 10.1007/s11428-018-0346-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Reynaud Q, Poupon-Bourdy S, Rabilloud M, Al Mufti L, Rousset Jablonski C, Lemonnier L, Nove-Josserand R, Touzet S, Durieu I. Pregnancy outcome in women with cystic fibrosis-related diabetes. Acta Obstet Gynecol Scand 2017. [DOI: 10.1111/aogs.13185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Quitterie Reynaud
- Cystic Fibrosis Adult Referral Care Center; Department of Internal Medicine; Civil Hospices of Lyon; EA-HESPER7425; University of Lyon; Lyon France
| | | | - Muriel Rabilloud
- Biostatistic Department; Civil Hospices of Lyon; University of Lyon; CNRS; UMR5558; Laboratory of Biometrics and Evolutionary Biology; Biostatistics-Health Team; Villeurbanne France
| | - Lina Al Mufti
- Biostatistic Department; Civil Hospices of Lyon; University of Lyon; CNRS; UMR5558; Laboratory of Biometrics and Evolutionary Biology; Biostatistics-Health Team; Villeurbanne France
| | - Christine Rousset Jablonski
- Cystic Fibrosis Adult Referral Care Center; Department of Internal Medicine; Civil Hospices of Lyon; EA-HESPER7425; University of Lyon; Lyon France
- Department of Obstetrics and Gynecology; South Lyon Hospital Center; Civil Hospices of Lyon; Pierre Bénite France
| | | | - Raphaële Nove-Josserand
- Cystic Fibrosis Adult Referral Care Center; Department of Internal Medicine; Civil Hospices of Lyon; EA-HESPER7425; University of Lyon; Lyon France
| | - Sandrine Touzet
- IMER Department; Civil Hospices of Lyon; EA-HESPER7425; University of Lyon; Lyon France
| | - Isabelle Durieu
- Cystic Fibrosis Adult Referral Care Center; Department of Internal Medicine; Civil Hospices of Lyon; EA-HESPER7425; University of Lyon; Lyon France
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Talwalkar JS, Koff JL, Lee HB, Britto CJ, Mulenos AM, Georgiopoulos AM. Cystic Fibrosis Transmembrane Regulator Modulators: Implications for the Management of Depression and Anxiety in Cystic Fibrosis. PSYCHOSOMATICS 2017; 58:343-354. [PMID: 28576305 DOI: 10.1016/j.psym.2017.04.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/29/2017] [Accepted: 04/03/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) are at high risk for depression and anxiety, which are associated with worse medical outcomes. Novel therapies for CF hold great promise for improving physical health, but the effects of these therapies on mental health remain poorly understood. OBJECTIVE This review aims to familiarize psychiatrists with the potential effect of novel CF therapies on depression and anxiety. METHODS We discuss novel therapies that directly target the mutant CF protein, the CF transmembrane regulator (CFTR), which are called CFTR modulators. We summarize depression and anxiety screening and treatment guidelines under implementation in accredited CF centers. Case vignettes highlight the complexities of caring for individuals with CF with comorbid depression and anxiety, including patients experiencing worsening depression and anxiety proximate to initiation of CFTR modulator therapy, and management of drug-drug interactions. CONCLUSIONS Although CFTR modulator therapies provide hope for improving clinical outcomes, worsening depression and anxiety occurs in some patients when starting these novel agents. This phenomenon may be multifactorial, with hypothesized contributions from CFTR modulator-psychotropic medication interactions, direct effects of CFTR modulators on central nervous system function, the psychologic effect of starting a potentially life-altering drug, and typical triggers of depression and anxiety such as stress, pain, and inflammation. The medical and psychiatric complexity of many individuals with CF warrants more direct involvement of mental health specialists on the multidisciplinary CF team. Inclusion of mental health variables in patients with CF registries will facilitate further examination at an epidemiologic level.
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Affiliation(s)
- Jaideep S Talwalkar
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Pediatrics, Yale School of Medicine, New Haven, CT.
| | - Jonathan L Koff
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Hochang B Lee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Clemente J Britto
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Arielle M Mulenos
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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