1
|
Izsák VD, Soós A, Szakács Z, Hegyi P, Juhász MF, Varannai O, Martonosi ÁR, Földi M, Kozma A, Vajda Z, Shaw JAM, Párniczky A. Screening Methods for Diagnosing Cystic Fibrosis-Related Diabetes: A Network Meta-Analysis of Diagnostic Accuracy Studies. Biomolecules 2021; 11:520. [PMID: 33807165 PMCID: PMC8065857 DOI: 10.3390/biom11040520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cystic fibrosis-related diabetes (CFRD) has become more common due to higher life expectancy with cystic fibrosis. Early recognition and prompt treatment of CFRD leads to improved outcomes. METHODS We performed a network meta-analysis (NMA) in order to identify the most valuable diagnostic metrics for diagnosing CFRD out of available screening tools (index test), using the oral glucose tolerance test as a reference standard. Pooled sensitivity (Se), specificity (Sp), and superiority indices were calculated and used to rank the index tests. RESULTS A total of 31 articles with 25 index tests were eligible for inclusion. Two-day, continuous glucose monitoring (CGM) ranked the highest (Se: 86% Sp: 76%), followed by glucose measurement from blood capillary samples (Se: 70%, Sp: 82%) and three-day CGM (Se: 96%, Sp: 56%). When we compared the CGM of different durations, two-day CGM performed best (Se: 88%, Sp: 80%), followed by three-day (Se: 96%, Sp: 59%) and six-day CGM (Se: 66%, Sp: 79%). CONCLUSIONS Considering its overall performance ranking, as well as the high sensitivity, two-day CGM appears to be a promising screening test for CFRD.
Collapse
Affiliation(s)
- Vera Dóra Izsák
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Alexandra Soós
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
- János Szentágothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Márk Félix Juhász
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
| | - Orsolya Varannai
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Ágnes Rita Martonosi
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Mária Földi
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Alexandra Kozma
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
| | - Zsolt Vajda
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
| | - James AM Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Andrea Párniczky
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| |
Collapse
|
2
|
Sheikh S, Localio AR, Kelly A, Rubenstein RC. Abnormal glucose tolerance and the 50-gram glucose challenge test in Cystic fibrosis. J Cyst Fibros 2020; 19:696-699. [PMID: 31974039 DOI: 10.1016/j.jcf.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 12/06/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
Diabetes has emerged as a major co-morbidity in cystic fibrosis (CF). The 75 g oral glucose tolerance test (OGTT) is used to screen for CF-related diabetes (CFRD) but is inconvenient, and adherence to screening is poor. The 50 g glucose challenge test (GCT) is shorter, performed non-fasting, and may serve to pre-screen the subset of individuals requiring confirmatory OGTT. We performed a pilot study in twenty-seven CF individuals across the glucose tolerance spectrum to test whether the GCT could identify subjects with abnormal glucose tolerance defined as 2-h OGTT glucose ≥7.8 mmol/L (2 h-AGT) or 1-h defined as 1-hr OGTT glucose ≥11.1 mmol/L (1 h-AGT). A GCT threshold of 8.1 mmol/L was 73% sensitive and 63% specific for 2hr-AGT and 80% sensitive and 65% specific for 1hr-AGT. Therefore, a screening GCT may reduce need for confirmatory OGTT for identifying AGT but a larger study is warranted to identify a robust cutoff for CFRD.
Collapse
Affiliation(s)
- Saba Sheikh
- Division of Pulmonary Medicine and The Cystic Fibrosis Center, The Children's Hospital of Philadelphia, Philadelphia, PA United States.
| | - A Russell Localio
- Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA United States
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA United States
| | - Ronald C Rubenstein
- Division of Pulmonary Medicine and The Cystic Fibrosis Center, The Children's Hospital of Philadelphia, Philadelphia, PA United States
| |
Collapse
|
4
|
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasian populations. Individuals with CF have seen significant increases in life expectancy in the last 60 years. As a result, previously rare complications are now coming to light. The most common of these is cystic fibrosis-related diabetes (CFRD), which affects 40-50% of CF adults. CFRD significantly impacts the pulmonary function and longevity of CF patients, yet a lack of consensus on the best methods to diagnose and treat CFRD remains. We begin by reviewing our understanding of the pathogenesis of CFRD, as emerging evidence shows the cystic fibrosis transmembrane conductance regulator (CFTR) also has important roles in the release of insulin and glucagon and in the protection of β cells from oxidative stress. We then discuss how current recommended methods of CFRD diagnosis are not appropriate, as continuous glucose monitoring becomes more effective, practical, and cost-effective. Finally, we evaluate emerging treatments which have narrowed the mortality gap within the CF patient group. In the future, pharmacological potentiators and correctors directly targeting CFTR show huge promise for both CFRD and the wider CF patient groups.
Collapse
Affiliation(s)
- Kayani Kayani
- Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Raihan Mohammed
- Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Raihan Mohammed,
| | - Hasan Mohiaddin
- Faculty of Medicine, Imperial College London, London, United Kingdom
| |
Collapse
|
5
|
Cano Megías M, González Albarrán O, Guisado Vasco P, Lamas Ferreiro A, Máiz Carro L. Resistencia insulínica, disfunción de la célula β pancreática y diferencias en los puntos intermedios de las curvas de glucemia e insulina tras una sobrecarga oral estándar de glucosa en adultos con fibrosis quística. ACTA ACUST UNITED AC 2015; 62:91-9. [DOI: 10.1016/j.endonu.2014.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/26/2014] [Accepted: 08/08/2014] [Indexed: 11/26/2022]
|
7
|
Abstract
Improved life expectancy in cystic fibrosis (CF) has led to an expanding population of adults with CF, now representing almost 50 % of the total CF population. This creates new challenges from long-term complications such as diabetes mellitus (DM), a condition that is present in 40 %-50 % of adults with CF. Cystic fibrosis-related diabetes (CFRD) results from a primary defect of insulin deficiency and although sharing features with type 1 (DM1) and type 2 diabetes (DM2), it is a clinically distinct condition. Progression to diabetes is associated with poorer CF clinical outcomes and increased mortality. CFRD is not associated with an increased risk of cardiovascular disease and the prevalence of microvascular complications is lower than DM1 or DM2. Rather, the primary goal of insulin therapy is the preservation of lung function and optimization of nutritional status. There is increasing evidence that appropriate screening and early intervention with insulin can reverse weight loss and improve pulmonary function. This approach may include targeting postprandial hyperglycemia not detected by standard diagnostic tests such as the oral glucose tolerance test. Further clinical research is required to guide when and how much to intervene in patients who are already dealing with the burden of one chronic illness.
Collapse
Affiliation(s)
- Donal O'Shea
- Department of Endocrinology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | | |
Collapse
|
8
|
Kern AS, Prestridge AL. Improving screening for cystic fibrosis-related diabetes at a pediatric cystic fibrosis program. Pediatrics 2013; 132:e512-8. [PMID: 23821699 DOI: 10.1542/peds.2012-4029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Despite guidelines recommending an annual oral glucose tolerance test (OGTT) for all patients with cystic fibrosis (CF) aged ≥ 10 years, screening rates for cystic fibrosis-related diabetes (CFRD) remained low at our center. The aim of this project was to implement an outpatient system to provide effective, evidence-based screening for CFRD at a pediatric CF program. METHODS Development of a system to improve outpatient screening for CFRD included structured education, communication with families, and processes for scheduling laboratory appointments. The primary outcome measure was the proportion of eligible patients seen at the clinic who received an OGTT by the subsequent clinic appointment. The proportion of patients without CFRD in our program who received an OGTT within the previous 12 months was also tracked longitudinally. RESULTS The outpatient screening rate for CFRD increased from 2% of eligible patients seen at the clinic during the 18 weeks before the start of our initiative to 78% during the 18 weeks after the start of our initiative (P < .001). The screening rate was also increased from the corresponding date range the previous year, when only 35% of eligible patients received an OGTT (P < .001). The overall percentage of patients without CFRD in our program who received an OGTT in the previous 12 months increased from 47% to 71% after implementation of our initiative (P = .003). CONCLUSIONS A systematic, quality improvement approach effectively increased the rate of outpatient screening for CFRD at a pediatric CF program.
Collapse
Affiliation(s)
- Andrew S Kern
- Department of Otolaryngology-Head and Neck Surgery, The Wexner Medical Center at Ohio State University, Columbus, Ohio 60611-2605, USA.
| | | |
Collapse
|
9
|
Coriati A, Elisha B, Virassamynaik S, Phaneuf M, Ziai S, Gauthier MS, Rabasa-Lhoret R. Diagnosis of cystic fibrosis-related glucose abnormalities: Can we shorten the standard oral glucose tolerance test? Appl Physiol Nutr Metab 2013; 38:1254-9. [PMID: 24195626 DOI: 10.1139/apnm-2013-0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adult patients with cystic fibrosis (APCF) are at high risk of developing impaired glucose tolerance (IGT) and CF-related diabetes (CFRD) and thus an annual screening with a 2-h oral glucose tolerance test (OGTT) is recommended. This population would greatly benefit from a simplified and harmless alternative to the standard OGTT. Thus, we aimed to compare the diagnostic values of HbA1c and glycemias at interval time points during the 2-h OGTT for IGT and CFRD detection in APCF. To do so, we conducted a cross-sectional analysis of 194 APCF with normal fasting plasma glucose values (≤ 7.0 mmol · L(-1)) who underwent a 2-h OGTT. Receivers operating characteristic area under the curves (ROC-AUC) were analyzed to assess the diagnostic value of HbA1c and intermediate OGTT glycemias using 2-h OGTT glycemia as reference. For both IGT and CFRD diagnoses, ROC-AUC values obtained from glycemia at 90 min were significantly higher than HbA1c and remaining intermediate glycemias (p < 0.001). The best 90-min OGTT cut-off values for these diagnoses were >9.3 mmol · L(-1) (IGT) and ≥ 11.5 mmol · L(-1) (CFRD). A 90-min OGTT glycemia might be a simplified alternative to 2-h OGTT glycemia for earlier glucose tolerance abnormalities diagnosis in APCF. This finding should be confirmed in other APCF cohorts and its predictive value should be established prospectively.
Collapse
Affiliation(s)
- Adèle Coriati
- Institut de Recherches Cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7, Canada
| | | | | | | | | | | | | |
Collapse
|