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Yalçın N, Akman ED, Karcıoğlu O, Allegaert K, Demirkan K, Damadoğlu E, Kalyoncu AF. Effect of Modulator Therapies on Nutritional Risk Index in Adults with Cystic Fibrosis: A Prospective Cohort Study. Nutrients 2024; 16:1811. [PMID: 38931166 DOI: 10.3390/nu16121811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Modulator therapies improve weight and body mass index (BMI) in cystic fibrosis (CF) patients. We aimed to compare the nutritional risk index (NRI) in adult CF patients receiving modulator (MT) or only non-modulator (conventional) therapies (non-MT). Methods: A single-center prospective cohort study was conducted between June and December 2023. The NRI based on weight gain and albumin was calculated at beginning and end of a 12-week period in both groups. This design was pragmatic, since it was based on individual patient access to MT for 12 weeks. Results: In total, 107 patients were included [mean (SD) age: 23.85 (4.98) years, 54.7% male, 46.7% MT]. In the MT group, mean (SD) weight (kg) and albumin (g/dL) increased significantly [changes: +3.09 (2.74) and +0.17 (0.37); p < 0.001]. In the non-MT group, weight and albumin decreased significantly [changes: -0.99 (1.73) and -0.12 (0.30); p < 0.001]. Compared to the MT group, baseline mean (SD) NRI in the non-MT group was significantly higher [100.65 (11.80) vs. 104.10 (10.10); p = 0.044]. At the end of the 12 weeks, mean (SD) NRI in the MT group was higher than in the non-MT group [104.18 (10.40) vs. 102.58 (12.39); p = 0.145]. In the MT group, the NRI category improved in 22 (44%), and worsened in 3 (6%) patients (p < 0.001). In the non-MT group, the NRI category improved in 2 (3.5%), and worsened in 10 (17.5%) patients (p < 0.001). Conclusions: This is the first study reporting on a positive effect of MT on NRIs, based on weight gain and albumin. Personalized nutrition and routine follow-up of adults with CF based on NRI is recommended prior to MT initiation.
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Affiliation(s)
- Nadir Yalçın
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06800 Ankara, Türkiye
| | - Esen Deniz Akman
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06800 Ankara, Türkiye
| | - Oğuz Karcıoğlu
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, 06800 Ankara, Türkiye
| | - Karel Allegaert
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000 Leuven, Belgium
- Department of Clinical Pharmacy, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06800 Ankara, Türkiye
| | - Ebru Damadoğlu
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, 06800 Ankara, Türkiye
| | - Ali Fuat Kalyoncu
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, 06800 Ankara, Türkiye
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Cohen A, Mass A, Reiter J, Zangen DH, Cohen-Cymberknoh M. Long-term therapy with CFTR modulators consistently improves glucose metabolism in adolescents and adults with cystic fibrosis. Respir Med 2024; 228:107664. [PMID: 38759874 DOI: 10.1016/j.rmed.2024.107664] [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: 07/27/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Impaired glycemic control and the subsequent development of Cystic fibrosis Related Diabetes (CFRD) are prevalent complications, affecting up to 50 % of adults with cystic fibrosis (CF). CFTR modulator (CFTRm) therapies improve pulmonary functions, reduce exacerbation rates, increase survival in people with CF (pwCF) and appear to have a positive effect on extrapulmonary manifestations, such as nutritional state, improvements in upper respiratory symptoms, and quality of life. Initial findings indicate that CFTRm may have a positive impact on short-term glycemic control; however, long-term effects remain uncertain at present. METHODS In this retrospective study, data were collected and analyzed on 15 pwCF, ages 13-37 years, started on CFTRm therapy. Oral Glucose Tolerance Test (OGTT) results were compared pre- and post-CFTRm therapy. RESULTS The 120-min OGTT value decreased from 159.7 mg/dL to 130.4 mg/dL post-CFTRm (p = 0.047). The average time elapsed between the two OGTTs was 49.87 months (ranging 9-157 months, median 38 months). Glycemic status improved in six pwCF (two CFRD to normal (NGT)/indeterminate (INDET) glucose tolerance; two impaired glucose tolerance (IGT) to INDET; two INDET to NGT) and worsened in one (IGT to CFRD). Six pwCF and NGT remained stable with no changes in glycemic status throughout the follow-up period. CONCLUSIONS CFTRm therapy may decelerate the glycemic control deterioration in pwCF over an extended period. These findings indicate the need for periodic OGTTs following the initiation of CFTRm therapy to appropriately adjust insulin requirements and prevent hypoglycemia. Further larger cohorts are required to authenticate and substantiate these findings.
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Affiliation(s)
- Amitay Cohen
- Division of Pediatric Endocrinology, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Alon Mass
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Joel Reiter
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Pediatric Pulmonary Unit and Cystic fibrosis Center, Hadassah Medical Center, Jerusalem, Israel
| | - David Haim Zangen
- Division of Pediatric Endocrinology, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Pediatric Pulmonary Unit and Cystic fibrosis Center, Hadassah Medical Center, Jerusalem, Israel.
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Amini M, Yu K, Liebich J, Ahir V, Wood E, Albert S, Dhindsa S. The Changing Landscape of Treatment for Cystic Fibrosis Related Diabetes. J Clin Transl Endocrinol 2024; 35:100332. [PMID: 38449771 PMCID: PMC10915598 DOI: 10.1016/j.jcte.2024.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
Objective Patients with Cystic Fibrosis related diabetes [CFRD] are treated with insulin and high calorie diets to maintain body mass. The combined CFTR modulator elexacaftor/tezacaftor/ivacaftor [ETI] decreases pulmonary exacerbations and improves nutritional status. We reviewed the effects of ETI on BMI, HbA1c and diabetes regimen in patients with CFRD over a period of three years. Methods Data of previously CFTR-modulator-naïve patients with CFRD and pancreatic insufficiency on ETI therapy were retrieved from an electronic health record database. Patients were followed for a mean duration of 2.7 ± 0.8 years after ETI initiation. Data pertaining to weight, BMI, HbA1c and diabetes regimen were collected at 6 months, 12 months, 2 years and at 3 years post-ETI initiation. Patients were then dichotomized based on their baseline BMI into a low BMI group and an "at target" BMI group. The effects of ETI on changes in weight, BMI, A1c and diabetes regimen were compared in both groups over a period of three years. Results Twenty-seven patients with CFRD (15 men/12 women), age 30.6 ± 11.5 (SD) years, BMI 22.4 ± 4.0 kg/m2, were included. Fifteen patients had low BMI (<22 kg/m2 for women, <23 kg/m2 for men) and 12 patients had at target BMI (≥22 kg/m2for women, ≥BMI 23 kg/m2 for men). Patients with low BMI had an increase in their BMI from 19.5 ± 1.7 to 21.4 ± 2.2 kg/m2 at one year (p = 0.002), and 21.8 ± 1.8 kg/m2 at three years (p = 0.004) after ETI initiation. Four patients (out of 15) in the low BMI group had achieved normal BMI by the end of study follow up. There was no change in weight in the at target BMI group. HbA1c and basal insulin requirements did not change in either group. Five patients started non-insulin therapies. Conclusion BMI increased after ETI therapy in CFRD patients with low BMI, but not in those with at target BMI. The use of non-insulin therapies is increasing in CFRD and should be evaluated in future studies.
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Affiliation(s)
- Mehdia Amini
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University School of Medicine, St. Louis, MO 63110, USA
| | - Kevin Yu
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University School of Medicine, St. Louis, MO 63110, USA
| | - Jessica Liebich
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University School of Medicine, St. Louis, MO 63110, USA
| | - Vaishaliben Ahir
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University School of Medicine, St. Louis, MO 63110, USA
| | - Emily Wood
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University School of Medicine, St. Louis, MO 63110, USA
| | - Stewart Albert
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University School of Medicine, St. Louis, MO 63110, USA
| | - Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University School of Medicine, St. Louis, MO 63110, USA
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Nielsen BU, Olsen MF, Mabuza Mathiesen IH, Pressler T, Ritz C, Katzenstein TL, Olesen HV, Skov M, Jensen-Fangel S, Almdal TP, Faurholt-Jepsen D. Decline in HbA1c during the first year of elexacaftor/tezacaftor/ivacaftor treatment in the Danish cystic fibrosis cohort: Short title: Decline in HbA1c after elexacaftor/tezacaftor/ivacaftor treatment. J Cyst Fibros 2024; 23:103-108. [PMID: 37989700 DOI: 10.1016/j.jcf.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/08/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Elexacaftor/tezacaftor/ivacaftor (ETI) has improved the clinical status of individuals with cystic fibrosis (CF), however, whether ETI impacts glucose tolerance remains unknown. We aimed to study the change in glycated hemoglobin (HbA1c) and CF related diabetes (CFRD) status after initiation of ETI. METHODS We included individuals ≥12 years treated with ETI in Denmark in a longitudinal observational study. HbA1c was measured at baseline, 3, 6, 9 and 12 months after treatment initiation. Change in HbA1c was assessed in mixed models adjusted for age, sex, glucose tolerance and prior CFTR modulator treatment. In a sub-population with CFRD, we assessed the change in insulin usage, hypoglycemic events and the 30-day continuous glucose monitoring (CGM) parameters (i.e., average blood glucose, time below (≤3.9 mM) and above (>10.0 mM) normal range, and the variation in glucose) after 12 months of treatment. RESULTS Among 321 individuals with CF, HbA1c declined by 2.1 mmol/mol [95 % confidence interval (CI): -2.6; -1.5 mmol/mol] after 3 months and by 2.3 mmol/mol [95 %CI: -2.8; -1.9 mmol/mol] after 12 months of ETI treatment. The decline was independent of glucose tolerance status at baseline. In 26 individuals with CFRD at baseline, the mean decline in HbA1c was 3.6 mmol/mol [95 %CI: -6.9; -0.4 mmol/mol] after 12 months, but we did not observe any change in insulin usage, weekly number of hypoglycemic events or CGM parameters. CONCLUSION In the Danish CF cohort, HbA1c declined over 12 months of ETI treatment, however, among a subset with CFRD, we observed no change in insulin usage and CGM glucose levels.
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Affiliation(s)
- Bibi Uhre Nielsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
| | - Mette Frahm Olsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, Frederiksberg C, Denmark
| | - Inger Hee Mabuza Mathiesen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Tacjana Pressler
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark; Cystic Fibrosis Centre Copenhagen, Department of Paediatrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen, Denmark
| | - Terese Lea Katzenstein
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Hanne Vebert Olesen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Hedeager 2, Aarhus, Denmark
| | - Marianne Skov
- Cystic Fibrosis Centre Copenhagen, Department of Paediatrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Søren Jensen-Fangel
- Department of Infectious Diseases, Aarhus University Hospital, Hedeager 2, Aarhus, Denmark
| | - Thomas Peter Almdal
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
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Anton-Păduraru DT, Murgu AM, Donos MA, Trofin F, Azoicăi AN, Popovici P, Stana AB, Gheorghiescu I, Trandafir LM. An Update in Cystic Fibrosis-Related Diabetes in Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1879. [PMID: 38136081 PMCID: PMC10741586 DOI: 10.3390/children10121879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
This paper delineates several aspects of cystic fibrosis-related diabetes (CFRD)-a common complication of cystic fibrosis (CF). CFRD exhibits a predilection for older individuals with CF, yet it also extends its influence on children and adolescents. Scientific insights postulate a potential link between CFRD and the aberrant mucus production within the pancreas, thereby culminating in pancreatic insufficiency. This, in turn, perturbs the synthesis of insulin, a pivotal endocrine hormone responsible for the regulation of glycemic levels. Standardized protocols advocate for the systematic screening of CFRD among all individuals with CF, commencing at the age of 10 years using the oral glucose tolerance test (OGTT). Therapeutic modalities encompass insulin therapy, dietary adjustments, and the vigilant monitoring of glycemic parameters. The overarching objective is to maintain blood glucose levels within a targeted range to mitigate the advent of diabetic complications. Untreated or sub-optimally managed CFRD can precipitate a spectrum of deleterious health ramifications, encompassing cardiovascular afflictions, neuropathy, renal dysfunction, and ocular complications.
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Affiliation(s)
- Dana-Teodora Anton-Păduraru
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (A.M.M.); (A.N.A.); (P.P.); (A.B.S.); (L.M.T.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania
| | - Alina Mariela Murgu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (A.M.M.); (A.N.A.); (P.P.); (A.B.S.); (L.M.T.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania
| | - Mădălina Andreea Donos
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (A.M.M.); (A.N.A.); (P.P.); (A.B.S.); (L.M.T.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania
| | - Felicia Trofin
- Department of Preventive Medicine and Interdisciplinarity—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Clinical Hospital of Infectious Diseases “Sf. Parascheva”, 700116 Iasi, Romania
| | - Alice Nicoleta Azoicăi
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (A.M.M.); (A.N.A.); (P.P.); (A.B.S.); (L.M.T.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania
| | - Paula Popovici
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (A.M.M.); (A.N.A.); (P.P.); (A.B.S.); (L.M.T.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania
| | - Aurelian Bogdan Stana
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (A.M.M.); (A.N.A.); (P.P.); (A.B.S.); (L.M.T.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania
| | - Ionela Gheorghiescu
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Laura Mihaela Trandafir
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-T.A.-P.); (A.M.M.); (A.N.A.); (P.P.); (A.B.S.); (L.M.T.)
- “Sf. Maria” Children Emergency Hospital, 700309 Iasi, Romania
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Kumar S, Soldatos G, Teede HJ, Pallin M. Effects of modulator therapies on endocrine complications in adults with cystic fibrosis: a narrative review. Med J Aust 2023; 219:496-502. [PMID: 37839059 DOI: 10.5694/mja2.52119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 10/17/2023]
Abstract
Cystic fibrosis is a monogenic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which transports chloride ions in secretory organs. Modulator therapies are small molecules that correct CFTR dysfunction and can lead to a wide range of benefits for both pulmonary and extrapulmonary complications of cystic fibrosis. With advancements in airway, antimicrobial and nutritional therapies and now introduction of modulator therapies, most people living with cystic fibrosis in Australia are now adults. For adults with cystic fibrosis, endocrine manifestations such as cystic fibrosis-related diabetes, metabolic bone disease, and reproductive health are becoming increasingly important, and emerging evidence on the endocrine effects of CFTR modulator therapies is promising and is shifting paradigms in our understanding and management of these conditions. The management of cystic fibrosis-related diabetes will likely need to pivot for high responders to modulator therapy with dietary adaptions and potential use of medications traditionally reserved for adults with type 2 diabetes, but evidence to support changing clinical care needs is currently lacking. Increased attention to diabetes-related complications screening will also be required. Increased exercise capacity due to improved lung function, nutrition and potentially direct modulator effect may have a positive impact on cystic fibrosis-related bone disease, but supporting evidence to date is limited. Fertility can improve in women with cystic fibrosis taking modulator therapy. This has important implications for pregnancy and lactation, but evidence is lacking to guide pre-conception and antenatal management. Provision of multidisciplinary clinical care remains ever-important to ensure the emergence of endocrine and metabolic complications are optimised in adults with cystic fibrosis.
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Affiliation(s)
- Shanal Kumar
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Adult Cystic Fibrosis Centre, Prince Charles Hospital, Brisbane, QLD
| | - Georgia Soldatos
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Monash Health, Melbourne, VIC
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Monash Health, Melbourne, VIC
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Lurquin F, Buysschaert M, Preumont V. Advances in cystic fibrosis-related diabetes: Current status and future directions. Diabetes Metab Syndr 2023; 17:102899. [PMID: 37939435 DOI: 10.1016/j.dsx.2023.102899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
AIMS The aim of this review is to give an update of the recent advances in the pathophysiology, prognosis, diagnosis and treatments of cystic fibrosis-related diabetes (CFRD). METHODS The literature survey focuses on original and review articles dealing with CFRD between 2006 and 2023, and in particular with: pathophysiology, risk and predictive factors, screening, chronic complications of CFRD, management and the effects of CFTR channel modulator therapies on glucose homeostasis, using PubMed®. RESULTS The rising prevalence of CFRD is due to prolonged life survival among patients with cystic fibrosis (CF). Advances in the understanding of the pathophysiology highlight the singularity of CFRD. Adherence to diagnostic guidelines remains challenging. Besides the classical OGTT, alternative diagnostic tests are being considered: HbA1c measurement, continuous glucose monitoring (CGM), intermediate measurements of alternative glucose tolerance stages through OGTT and homeostatic model assessment (HOMA). Early treatment of (pre)diabetes in CF patients is mandatory. The advent of CFTR channel modulator therapies have created a paradigm shift in the management of CF: they seem to improve glucose homeostasis, but the mechanism remains unclear. CONCLUSION CFRD management is an ongoing concern. Optimal care has reduced the negative impact of CFRD on lung function, nutrition, and survival. Increasing prevalence of CFRD and prolonged lifespan lead to more microvascular complications. New screening tools (Hba1c, CGM, HOMA) show potential for better classification of patients. The effect of CFTR modulators on glucose metabolism warrants further research.
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Affiliation(s)
- F Lurquin
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium.
| | - M Buysschaert
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - V Preumont
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
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Collins S, Jones A, Woodward S, Sturt J. "It is like a pet in a way": The self-management experiences of people with cystic fibrosis diabetes. J Hum Nutr Diet 2023; 36:1621-1635. [PMID: 37158099 DOI: 10.1111/jhn.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cystic fibrosis diabetes (CFD) is a very common co-morbidity affecting the lives of people with cystic fibrosis. Surprisingly, minimal research has been undertaken to understand the experiences of people with CFD and how they self-mange this condition. METHODS Using interpretative phenomenological analysis, the present study examined the self-management experiences of people with CFD. In-depth semi-structure interviews were conducted with eight people who had CFD. RESULTS The following three superordinate themes were identified: forming a relationship with CFD, balancing the CFD self-management triad, and the unmet need for information and support. CONCLUSIONS The findings suggest that the management of CFD is challenging and, although people with CFD experience many adaptation and management processes similar to people with type 1 diabetes, they struggle with the additional complexity of balancing CF and CFD. The provision of appropriate education, support and person-centred care needs to be addressed.
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Affiliation(s)
| | - Andrew Jones
- Royal Brompton & Harefield Hospitals, London, UK
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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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Lurquin F, Gohy S, Hermans MP, Preumont V. Combined CFTR modulator therapies are linked with anabolic benefits and insulin-sparing in cystic fibrosis-related diabetes. J Clin Transl Endocrinol 2023; 33:100320. [PMID: 37448650 PMCID: PMC10336243 DOI: 10.1016/j.jcte.2023.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Aims Combined CFTR modulator therapies have dramatically altered pulmonary outcomes in patients with cystic fibrosis (CF). Their impact on glucose metabolism requires further investigations. This study aims to evaluate insulin requirements after initiation of combined CFTR modulator therapy in patients with CF-related diabetes (CFRD) and HOMA indices changes in CF patients without diabetes. Methods We retrospectively analyzed: 1) the effects of tezacaftor + ivacaftor and elexacaftor + tezacaftor + ivacaftor on FEV1, weight, BMI, HbA1c, and daily insulin dose, in 17 CFRD patients and 2) the impact of tezacaftor + ivacaftor on HOMA indices in 15 CF patients without diabetes. Results Age was 37±12y in the CFRD group (70% men), 88% of whom were homozygous for F508del mutation. Diabetes duration was 15±10y. Median duration of combined CFTR modulator therapy was 16 months (IQR: 4) Thirteen patients received tezacaftor + ivacaftor, of whom 9 were switched to elexacaftor + tezacaftor + ivacaftor. Four patients received elexacaftor + tezacaftor + ivacaftor up front. A decrease in insulin needs was noticed in 88% of patients (0.85±0.3 vs 0.71±0.3U/kg/day; p = 0001). Total daily insulin dose decreased from 50±16 to 44±20U/day (p = 0.017). BMI improved (20.9 (IQR: 1.90) vs 22.1 kg/m2 (IQR: 3.70); p = 0.014). HbA1c went from 7.3±1.1 to 7.7±1.6% (p = 0.072). Median age was 22y (IQR: 11) in the CF group without diabetes (67% men), 93% of whom were homozygous for F508del mutation. Duration of combined CFTR modulator therapy was 10±5 months. HOMA-B changes were not significant (129.2 (IQR: 84.8) vs 103.5% (IQR: 66.3) nor were HOMA-S changes (from 94±64 to 95±49%). HOMA-BxS decreased from 112±45 to 104±29% (NS). BMI rose from 21.9±3 to 23.1±3.5 kg/m2 (p = 0.047). HbA1c was unchanged (5.0±0.5%). FEV1 improved in both groups (+11% and + 7% of predicted value; p < 0.001; p = 0.013). Conclusion Combined CFTR modulator therapies are correlated with a decrease in insulin doses and positive effects on BMI and FEV1. HOMA indices did not change on tezacaftor + ivacaftor among CF patients without diabetes.
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Affiliation(s)
- Fabian Lurquin
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Sophie Gohy
- Department of Pneumology, CF Reference Center, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Michel P. Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Vanessa Preumont
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
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11
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Uytun S, Cinel G, Eryılmaz Polat S, Özkan Tabakçı S, Kiper N, Yalçın E, Ademhan Tural D, Özsezen B, Şen V, Selimoğlu Şen H, Ufuk Altıntaş D, Çokuğraş H, Kılınç AA, Başkan AK, Yazan H, Çollak A, Uzuner S, Ünal G, Yılmaz Aİ, Çağlar HT, Damadoğlu E, Irmak İ, Demir E, Kartal Öztürk G, Bingöl A, Başaran E, Sapan N, Canıtez Y, Tana Aslan A, Asfuroğlu P, Harmancı K, Köse M, Hangül M, Özdemir A, Çobanoğlu N, Özcan G, Keskin Ö, Yüksel H, Özdoğan Ş, Topal E, Çaltepe G, Can D, Korkmaz Ekren P, Kılıç M, Emiralioğlu N, Şişmanlar Eyüboğlu T, Pekcan S, Çakır E, Özçelik U, Doğru D. Patients with cystic fibrosis who could not receive the CFTR modulator treatment: What did they lose in 1 year? Pediatr Pulmonol 2023; 58:2505-2512. [PMID: 37278544 DOI: 10.1002/ppul.26535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/29/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is an autosomal recessive disorder caused by CF transmembrane conductance regulator (CFTR) genetic variants. CFTR modulators improve pulmonary function and reduce respiratory infections in CF. This study investigated the clinical and laboratory follow-up parameters over 1 year in patients with CF who could not receive this treatment. METHODS This retrospective cohort study included 2018 and 2019 CF patient data from the CF registry of Turkey. Demographic and clinical characteristics of 294 patients were assessed, who had modulator treatment indications in 2018 but could not reach the treatment. RESULTS In 2019, patients younger than 18 years had significantly lower BMI z-scores than in 2018. During the 1-year follow-up, forced expiratory volumes (FEV1) and FEV1 z-scores a trend toward a decrease. In 2019, chronic Staphylococcus aureus colonization, inhaled antipseudomonal antibiotic use for more than 3 months, oral nutritional supplement requirements, and oxygen support need increased. CONCLUSIONS Patients who had indications for modulator treatments but were unable to obtain them worsened even after a year of follow-up. This study emphasized the importance of using modulator treatments for patients with CF in our country, as well as in many countries worldwide.
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Affiliation(s)
- Salih Uytun
- Division of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Güzin Cinel
- Division of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | | | | | - Nural Kiper
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalçın
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilber Ademhan Tural
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Beste Özsezen
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Velat Şen
- Division of Pediatric Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Hadice Selimoğlu Şen
- Department of Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Derya Ufuk Altıntaş
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Haluk Çokuğraş
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ayşe Ayzıt Kılınç
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Azer Kılıç Başkan
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Abdulhamit Çollak
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Selçuk Uzuner
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Gökçen Ünal
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Aslı İmran Yılmaz
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hanife Tuğçe Çağlar
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ebru Damadoğlu
- Department of Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlim Irmak
- Department of Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Esen Demir
- Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Gökçen Kartal Öztürk
- Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ayşen Bingöl
- Division of Pediatric Pulmonology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Erdem Başaran
- Division of Pediatric Pulmonology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Nihat Sapan
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Yakup Canıtez
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ayşe Tana Aslan
- Division of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Pelin Asfuroğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Koray Harmancı
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Mehmet Köse
- Division of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Melih Hangül
- Division of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Özdemir
- Division of Pediatric Pulmonology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Nazan Çobanoğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gizem Özcan
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özlem Keskin
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Hasan Yüksel
- Division of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Şebnem Özdoğan
- Division of Pediatric Pulmonology, Sarıyer Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Erdem Topal
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Gönül Çaltepe
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Demet Can
- Division of Pediatric Pulmonology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | | | - Mehmet Kılıç
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Nagehan Emiralioğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Sevgi Pekcan
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Erkan Çakır
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Uğur Özçelik
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Doğru
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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12
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Ekblond RS, Nielsen BU, Højte C, Almdal TP, Shaw J, Pressler T, Faurholt-Jepsen D, Mathiesen IHM. Changes in glucose tolerance in people with cystic fibrosis after initiation of first-generation CFTR modulator treatment. Pediatr Pulmonol 2023; 58:2600-2609. [PMID: 37341613 DOI: 10.1002/ppul.26562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/20/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Cystic fibrosis transmembrane conductance regulator (CFTR) modulators have been shown to have a beneficial effect on pulmonary function and nutritional status in patients with cystic fibrosis (CF), but the extent to which they affect glucose tolerance is not fully understood. In the current study, we evaluated the change in glucose tolerance and insulin secretion after first-generation CFTR modulator treatment in adults with CF. METHODS We performed a longitudinal observational study with an oral glucose tolerance test performed at baseline and after three and a half years of follow-up. The test comprised glucose, C-peptide and insulin measured at fasting, 1 h, and 2 h, and HbA1c at fasting. We compared changes in parameters of glucose tolerance and insulin secretion from baseline to follow-up. RESULTS Among 55 participants, 37 (67%) were treated with a first-generation CFTR modulator for a median of 21 months. Glucose levels were unchanged in both the treated and untreated group. In the treated group, C-peptide levels declined, yet no significant differences in glucose, insulin, and C-peptide levels were observed between the groups. HbA1c increased in both groups, while no significant change in the insulin sensitivity indices was detected in either group. However, homeostatic model assessment for insulin resistance tended to decline in the treated group, whilst tending towards an increase in the untreated group. The difference between the groups reached statistical significance (p = 0.040). CONCLUSION Treatment with first-generation CFTR modulators, mainly tezacaftor/ivacaftor, did not seem to be associated with glucose tolerance nor insulin secretion in adults with CF. However, CFTR modulators may still have a beneficial effect on insulin sensitivity.
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Affiliation(s)
- Rikke Spragge Ekblond
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bibi Uhre Nielsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christine Højte
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Peter Almdal
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - James Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tacjana Pressler
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Inger Hee Mabuza Mathiesen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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13
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Steinack C, Ernst M, Beuschlein F, Hage R, Roeder M, Schuurmans MM, Schmid C, Gaisl T. Improved glucose tolerance after initiation of Elexacaftor / Tezacaftor / Ivacaftor in adults with cystic fibrosis. J Cyst Fibros 2023; 22:722-729. [PMID: 36669960 DOI: 10.1016/j.jcf.2023.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND The novel triple CFTR modulator therapy Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) improves lung function, body mass index (BMI), sinus clearance, and quality of life in patients with cystic fibrosis. Whether treatment with ELX/TEZ/IVA is associated with improved glucose tolerance is unknown. METHODS This cohort study included adults with CF and at least one copy of F508del.. Study assessments before treatment and at least 3 months after ELX/TEZ/IVA initiation included an oral glucose tolerance test (OGTT) with glucose and insulin measurements, BMI, lung function test, and sweat chloride levels. We used an analysis of response profiles to calculate changes in outcomes. RESULTS 33 patients (27.8 ± 6.3 years; 73% male; 64% F508del homozygous) were included. After a median of 184 [IQR, 107 - 278] days following treatment initiation 16 (48.5%) patients improved their glucose tolerance category, while 13 (39.4%) remained unchanged and 4 (12.1%) deteriorated. Overall, 60, 90 and 120 min OGTT glycemia decreased significantly from 11.9 ± 2.7 mmol/l to 10.6 ± 2.8 mmol/l (p = 0.012), 10.4 ± 3.0 mmol/l to 8.4 ± 3.6 mmol/l (p = 0.002) and 7.3 ± 3.1 mmol/l to 5.7 ± 3.0 mmol/l (p = 0.012). HbA1c levels also improved significantly, from 5.50±0.24% to 5.39±0.25% (p = 0.039). CONCLUSION In adult patients with CF and at least one copy of F508del, treatment with the triple CFTR modulator was associated with possible improvement of glucose tolerance without increases of insulin secretion. Early initiation of treatment as assessed through long-term prospective trials is mandatory to demonstrate if decreased glucose control is preventable or even reversible.
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Affiliation(s)
- Carolin Steinack
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland.
| | - Matthias Ernst
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | - René Hage
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Schmid
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland
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14
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Putman MS, Norris AW, Hull RL, Rickels MR, Sussel L, Blackman SM, Chan CL, Ode KL, Daley T, Stecenko AA, Moran A, Helmick MJ, Cray S, Alvarez JA, Stallings VA, Tuggle KL, Clancy JP, Eggerman TL, Engelhardt JF, Kelly A. Cystic Fibrosis-Related Diabetes Workshop: Research Priorities Spanning Disease Pathophysiology, Diagnosis, and Outcomes. Diabetes Care 2023; 46:1112-1123. [PMID: 37125948 PMCID: PMC10234745 DOI: 10.2337/dc23-0380] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 05/02/2023]
Abstract
Cystic fibrosis (CF) is a recessive disorder arising from mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. CFTR is expressed in numerous tissues, with high expression in the airways, small and large intestine, pancreatic and hepatobiliary ducts, and male reproductive tract. CFTR loss in these tissues disrupts regulation of salt, bicarbonate, and water balance across their epithelia, resulting in a systemic disorder with progressive organ dysfunction and damage. Pancreatic exocrine damage ultimately manifests as pancreatic exocrine insufficiency that begins as early as infancy. Pancreatic remodeling accompanies this early damage, during which abnormal glucose tolerance can be observed in toddlers. With increasing age, however, insulin secretion defects progress such that CF-related diabetes (CFRD) occurs in 20% of teens and up to half of adults with CF. The relevance of CFRD is highlighted by its association with increased morbidity, mortality, and patient burden. While clinical research on CFRD has greatly assisted in the care of individuals with CFRD, key knowledge gaps on CFRD pathogenesis remain. Furthermore, the wide use of CFTR modulators to restore CFTR activity is changing the CFRD clinical landscape and the field's understanding of CFRD pathogenesis. For these reasons, the National Institute of Diabetes and Digestive and Kidney Diseases and the Cystic Fibrosis Foundation sponsored a CFRD Scientific Workshop, 23-25 June 2021, to define knowledge gaps and needed research areas. This article describes the findings from this workshop and plots a path for CFRD research that is needed over the next decade.
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Affiliation(s)
- Melissa S. Putman
- Division of Pediatric Endocrinology, Boston Children’s Hospital, Boston, MA
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Andrew W. Norris
- Department of Pediatrics, University of Iowa, Iowa City, IA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
| | - Rebecca L. Hull
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA
- Research Service, VA Puget Sound Health Care System, Seattle
| | - Michael R. Rickels
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lori Sussel
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Scott M. Blackman
- Division of Pediatric Endocrinology and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine L. Chan
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Katie Larson Ode
- Department of Pediatrics, University of Iowa, Iowa City, IA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
| | - Tanicia Daley
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Arlene A. Stecenko
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Department of Pediatrics, Emory University, Atlanta, GA
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - Virginia A. Stallings
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA
| | | | | | - Thomas L. Eggerman
- Division of Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John F. Engelhardt
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
- Department of Anatomy and Cell Biology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Andrea Kelly
- Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA
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15
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Putman MS, Norris AW, Hull RL, Rickels MR, Sussel L, Blackman SM, Chan CL, Ode KL, Daley T, Stecenko AA, Moran A, Helmick MJ, Cray S, Alvarez JA, Stallings VA, Tuggle KL, Clancy JP, Eggerman TL, Engelhardt JF, Kelly A. Cystic Fibrosis-Related Diabetes Workshop: Research Priorities Spanning Disease Pathophysiology, Diagnosis, and Outcomes. Diabetes 2023; 72:677-689. [PMID: 37125945 PMCID: PMC10202770 DOI: 10.2337/db22-0949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 05/02/2023]
Abstract
Cystic fibrosis (CF) is a recessive disorder arising from mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. CFTR is expressed in numerous tissues, with high expression in the airways, small and large intestine, pancreatic and hepatobiliary ducts, and male reproductive tract. CFTR loss in these tissues disrupts regulation of salt, bicarbonate, and water balance across their epithelia, resulting in a systemic disorder with progressive organ dysfunction and damage. Pancreatic exocrine damage ultimately manifests as pancreatic exocrine insufficiency that begins as early as infancy. Pancreatic remodeling accompanies this early damage, during which abnormal glucose tolerance can be observed in toddlers. With increasing age, however, insulin secretion defects progress such that CF-related diabetes (CFRD) occurs in 20% of teens and up to half of adults with CF. The relevance of CFRD is highlighted by its association with increased morbidity, mortality, and patient burden. While clinical research on CFRD has greatly assisted in the care of individuals with CFRD, key knowledge gaps on CFRD pathogenesis remain. Furthermore, the wide use of CFTR modulators to restore CFTR activity is changing the CFRD clinical landscape and the field's understanding of CFRD pathogenesis. For these reasons, the National Institute of Diabetes and Digestive and Kidney Diseases and the Cystic Fibrosis Foundation sponsored a CFRD Scientific Workshop, 23-25 June 2021, to define knowledge gaps and needed research areas. This article describes the findings from this workshop and plots a path for CFRD research that is needed over the next decade.
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Affiliation(s)
- Melissa S. Putman
- Division of Pediatric Endocrinology, Boston Children’s Hospital, Boston, MA
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Andrew W. Norris
- Department of Pediatrics, University of Iowa, Iowa City, IA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
| | - Rebecca L. Hull
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA
- Research Service, VA Puget Sound Health Care System, Seattle, WA
| | - Michael R. Rickels
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lori Sussel
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Scott M. Blackman
- Division of Pediatric Endocrinology and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine L. Chan
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Katie Larson Ode
- Department of Pediatrics, University of Iowa, Iowa City, IA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
| | - Tanicia Daley
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Arlene A. Stecenko
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Department of Pediatrics, Emory University, Atlanta, GA
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - Virginia A. Stallings
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA
| | | | | | - Thomas L. Eggerman
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John F. Engelhardt
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
- Department of Anatomy and Cell Biology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Andrea Kelly
- Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA
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16
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Weiss L, Reix P, Mosnier-Pudar H, Ronsin O, Beltrand J, Reynaud Q, Mely L, Burgel PR, Stremler N, Rakotoarisoa L, Galderisi A, Perge K, Bendelac N, Abely M, Kessler L. Screening strategies for glucose tolerance abnormalities and diabetes in people with cystic fibrosis. DIABETES & METABOLISM 2023; 49:101444. [PMID: 37030530 DOI: 10.1016/j.diabet.2023.101444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/21/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
The increase in life expectancy of patients with cystic fibrosis has come with new comorbidities, particularly diabetes. The gradual development of glucose tolerance abnormalities means that 30 to 40% of adults will be diabetic. Cystic fibrosis-related diabetes is a major challenge in the care of these patients because it is a morbidity and mortality factor at all stages of the disease. Early glucose tolerance abnormalities observed from childhood, before the stage of diabetes, are also associated with a poor pulmonary and nutritional outcome. The long asymptomatic period justifies systematic screening with an annual oral glucose tolerance test from the age of 10 years. However, this strategy does not take into account the new clinical profiles of patients with cystic fibrosis, recent pathophysiological knowledge of glucose tolerance abnormalities, and the emergence of new diagnostic tools in diabetology. In this paper, we summarise the challenges of screening in the current context of new patient profiles - patients who are pregnant, have transplants, or are being treated with fibrosis conductance transmembrane regulator modulators - and put forward an inventory of the various screening methods for cystic fibrosis-related diabetes, including their applications, limitations and practical implications.
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17
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Regard L, Martin C, Da Silva J, Burgel PR. CFTR Modulators: Current Status and Evolving Knowledge. Semin Respir Crit Care Med 2023; 44:186-195. [PMID: 36535667 DOI: 10.1055/s-0042-1758851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the past decade, the medical management of people with cystic fibrosis (pwCF) has changed with the development of small molecules that partially restore the function of the defective CF transmembrane conductance regulator (CFTR) protein and are called CFTR modulators. Ivacaftor (IVA), a CFTR potentiator with a large effect on epithelial ion transport, was the first modulator approved in pwCF carrying gating mutations. Because IVA was unable to restore sufficient CFTR function in pwCF with other mutations, two CFTR correctors (lumacaftor and tezacaftor) were developed and used in combination with IVA in pwCF homozygous for F508del, the most common CFTR variant. However, LUM/IVA and TEZ/IVA were only moderately effective in F508del homozygous pwCF and had no efficacy in those with F508del and minimal function mutations. Elexacaftor, a second-generation corrector, was thus developed and combined to tezacaftor and ivacaftor (ELX/TEZ/IVA) to target pwCF with at least one F508del variant, corresponding to approximately 85% of pwCF. Both IVA and ELX/TEZ/IVA are considered highly effective modulator therapies (HEMTs) in eligible pwCF and are now approved for nearly 90% of the CF population over 6 years of age. HEMTs are responsible for rapid improvement in respiratory manifestations, including improvement in symptoms and lung function, and reduction in the rate of pulmonary exacerbations. The impact of HEMT on extrapulmonary manifestations of CF is less well established, although significant weight gain and improvement in quality of life have been demonstrated. Recent clinical trials and real-world studies suggest that benefits of HEMT could even prove greater when used earlier in life (i.e., in younger children and infants). This article shortly reviews the past 10 years of development and use of CFTR modulators. Effects of HEMT on extrapulmonary manifestations and on CF demographics are also discussed.
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Affiliation(s)
- Lucile Regard
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,Institut Cochin and Université de Paris, INSERM U1016, Paris, France.,ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Clémence Martin
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,Institut Cochin and Université de Paris, INSERM U1016, Paris, France.,ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Jennifer Da Silva
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Pierre-Régis Burgel
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,Institut Cochin and Université de Paris, INSERM U1016, Paris, France.,ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
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18
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Foppiani A, Ciciriello F, Bisogno A, Bricchi S, Colombo C, Alghisi F, Lucidi V, Catena MA, Lucanto M, Mari A, Bedogni G, Battezzati A. Distribution of OGTT-Related Variables in Patients with Cystic Fibrosis from Puberty to Adulthood: An Italian Multicenter Study. J Pers Med 2023; 13:jpm13030469. [PMID: 36983651 PMCID: PMC10056682 DOI: 10.3390/jpm13030469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Background: Insulin secretion and glucose tolerance is annually assessed in patients with cystic fibrosis (PwCF) through oral glucose tolerance tests (OGTTs) as a screening measure for cystic fibrosis-related diabetes. We aimed to describe the distribution and provide reference quartiles of OGTT-related variables in the Italian cystic fibrosis population. Methods: Cross-sectional study of PwCF receiving care in three Italian cystic fibrosis centers of excellence, from 2016 to 2020. We performed a modified 2-h OGTT protocol (1.75 g/kg, maximum 75 g), sampling at baseline and at 30-min intervals, analyzing plasma glucose, serum insulin, and C-peptide. The modified OGTT allowed for the modeling of β cell function. For all variables, multivariable quantile regression was performed to estimate the median, the 25th, and 75th percentiles, with age, sex, and pancreatic insufficiency as predictors. Results: We have quantified the deterioration of glucose tolerance and insulin secretion with age according to sex and pancreatic insufficiency, highlighting a deviation from linearity both for patients <10 years and >35 years of age. Conclusions: References of OGTT variables for PwCF provide a necessary tool to not only identify patients at risk for CFRD or other cystic fibrosis-related complications, but also to evaluate the effects of promising pharmacological therapies.
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Affiliation(s)
- Andrea Foppiani
- ICANS-DIS, Department of Food Environmental and Nutritional Sciences, University of Milan, 20133 Milan, Italy
| | - Fabiana Ciciriello
- Cystic Fibrosis Unit, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Arianna Bisogno
- Pediatric Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Com-menda 9, 20122 Milano, Italy
| | - Silvia Bricchi
- Pediatric Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Com-menda 9, 20122 Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milano, Italy
| | - Carla Colombo
- Pediatric Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Com-menda 9, 20122 Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milano, Italy
| | - Federico Alghisi
- Cystic Fibrosis Unit, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Vincenzina Lucidi
- Cystic Fibrosis Unit, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Maria Ausilia Catena
- Cystic Fibrosis Hub Center, Azienda Ospedaliera Universitaria Policlinico G. Martino, 98125 Messina, Italy
| | - Mariacristina Lucanto
- Cystic Fibrosis Hub Center, Azienda Ospedaliera Universitaria Policlinico G. Martino, 98125 Messina, Italy
| | - Andrea Mari
- Institute of Neuroscience, National Research Council, 35127 Padova, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Internal Medicine Unit Addressed to Frailty and Aging, Department of Primary Health Care, S. Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Alberto Battezzati
- ICANS-DIS, Department of Food Environmental and Nutritional Sciences, University of Milan, 20133 Milan, Italy
- Clinical Nutrition Unit, Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
- Correspondence:
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19
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Declercq D, Helleputte S, Marchand S, Van Aken S, Van Braeckel E, Van Daele S, T'Sjoen G, Van Biervliet S, Lapauw B. Glycemic indices at night measured by CGM are predictive for a lower pulmonary function in adults but not in children with cystic fibrosis. J Cyst Fibros 2023; 22:59-65. [PMID: 36068119 DOI: 10.1016/j.jcf.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/17/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In patients with cystic fibrosis (CF), it is still unclear to which extent glucose abnormalities - preceding the diagnosis of cystic fibrosis related diabetes (CFRD) - are associated with pulmonary and nutritional outcome parameters. This study related circadian glycemic patterns to clinical outcomes in a group of CF patients not previously diagnosed with diabetes. METHODS Continuous glucose monitoring (CGM) readings (7 days) of 47 CF patients (26 children, 21 adults) with an impaired oral glucose tolerance test (OGTT) (n = 25) and/or increased Hb1Ac (> 5.5%) were analyzed. Biometric, pulmonary function and clinical parameters were retrospectively collected over a period of 1 year before (T-1) and 1 year after (T + 1) CGM (T0). RESULTS 96% (45/47) of CGM readings showed glucose values > 140 mg/dL ≥ 4.5% of the time and at least one ≥ 200 mg/dL. In the pediatric cohort, no significant associations were found between CGM parameters and pulmonary and nutritional outcome parameters. In the adult cohort, an area under the curve (AUC) > 140 mg/dL and%-time > 140 mg/dL during the night were associated with a lower forced expiratory volume in 1 s (FEV1)% predicted (pp) at time of evaluation but not with change in FEV1pp. CONCLUSION This is the first study reporting the circadian glycemic pattern in children and adults at risk for CFRD. In the adult cohort an association between detection of abnormal glucose exposure and a lower FEV1pp was found. Our results support continued screening for glucose intolerance in patients with CF.
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Affiliation(s)
- Dimitri Declercq
- Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium; Department of Pediatrics, Centre for Children and Adolescents with Diabetes, Ghent University Hospital, Ghent, Belgium; Centre for Nutrition and Dietetics, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Simon Helleputte
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Sophie Marchand
- Centre for Nutrition and Dietetics, Ghent University Hospital, Ghent, Belgium.
| | - Sara Van Aken
- Department of Pediatrics, Centre for Children and Adolescents with Diabetes, Ghent University Hospital, Ghent, Belgium.
| | - Eva Van Braeckel
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium.
| | - Sabine Van Daele
- Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Guy T'Sjoen
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
| | - Stephanie Van Biervliet
- Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Bruno Lapauw
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
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20
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Prentice B, Nicholson M, Lam GY. Cystic fibrosis related diabetes (CFRD) in the era of modulators: A scoping review. Paediatr Respir Rev 2022:S1526-0542(22)00086-0. [PMID: 36581478 DOI: 10.1016/j.prrv.2022.11.005] [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: 08/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Cystic fibrosis-related diabetes (CFRD) is a common complication of CF that increases in incidence as patients age. Poor glycemic control has been shown to negatively impact lung function and weight, resulting in higher risk of recurrent pulmonary exacerbations. With the advent of highly effective modulator therapies (HEMT), patients with CF are living longer and healthier lives. Consequently, CFRD and its microvascular complications are rising in prominence, becoming one of the most urgent clinical concerns. As HEMT were developed with the primary focus of improving pulmonary outcomes, it is not clear from the original phase III studies what the short- or long-term benefits of modulators might be on CFRD development and trajectory. In this review, we will examine the pathophysiology of CFRD, summarize and synthesize the available evidence of HEMT impact on CFRD and describe the emerging research needs in this field.
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Affiliation(s)
- Bernadette Prentice
- Department of Respiratory Medicine, Sydney Children's Hospital, Randwick Australia; Molecular and Integrative Cystic Fibrosis (miCF) Research Centre, Randwick, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Randwick, Australia
| | - Mike Nicholson
- Division of Respirology, Department of Medicine, Western University, Ontario, Canada
| | - Grace Y Lam
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta, Canada.
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21
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Kelly A, Marks BE, Stalvey MS. Endocrine Complications of Cystic Fibrosis. Clin Chest Med 2022; 43:773-789. [PMID: 36344080 DOI: 10.1016/j.ccm.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Endocrine comorbidities have become increasingly important medical considerations as improving cystic fibrosis (CF) care increases life expectancy. Although the underlying pathophysiology of CF-related diabetes remains elusive, the use of novel technologies and therapeutics seeks to improve both CF-related outcomes and quality of life. Improvements in the overall health of those with CF have tempered concerns about pubertal delay and short stature; however, other comorbidities such as hypogonadism and bone disease are increasingly recognized. Following the introduction of highly effective modulator therapies there are many lessons to be learned about their long-term impact on endocrine comorbidities.
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Affiliation(s)
- Andrea Kelly
- Division of Endocrinology & Diabetes, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Room 14363, Roberts Building for Pediatric Research, 2716 South Street, Philadelphia, PA 19146, USA
| | - Brynn E Marks
- Division of Endocrinology & Diabetes, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Room 7547, The Hub for Clinical Collaboration, 3501 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Michael S Stalvey
- Department of Pediatrics, UAB Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Children's of Alabama, CPPII M30, 1600 7th Avenue South, Birmingham, AL 35233-1711, USA; Department of Medicine, UAB Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Children's of Alabama, CPPII M30, 1600 7th Avenue South, Birmingham, AL 35233-1711, USA.
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22
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Chan CL, Granados A, Moheet A, Singh S, Vigers T, Arbeláez AM, Yi Y, Hu S, Norris AW, Ode KL. Glycemia and β-cell function before and after elexacaftor/tezacaftor/ivacaftor in youth and adults with cystic fibrosis. J Clin Transl Endocrinol 2022; 30:100311. [PMID: 36620757 PMCID: PMC9816065 DOI: 10.1016/j.jcte.2022.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background Diabetes is prevalent among people with CF (PwCF) and associated with worse clinical outcomes. CFTR modulators are highly effective in improving the disease course of CF. However, the effects of elexacaftor/tezacaftor/ivacaftor (ETI) on glucose metabolism in PwCF are unclear. Methods Twenty youth and adults with CF underwent frequently sampled oral glucose tolerance tests (fsOGTT) before and after ETI initiation. Glucose, insulin, and C-peptide were collected at 0, 10, 30, 60, 90, and 120 min after 1.75 g/kg (max 75 g) of dextrose. HbA1c and continuous glucose monitoring (CGM) were collected in a subset. Estimates of insulin secretion (C-peptide index), insulin resistance (HOMA2 IR and IS(OGTT Cpep)), and β-cell function (C-peptide oral disposition index, oDIcoeo), were compared before and after ETI. Results Participants were a median (IQR) of 20.4 (14.1, 28.6) years old, 75 % male. Follow-up occurred 10.5 (10.0, 12.3) months after ETI initiation. BMI z-score increased from 0.3 (-0.3, 0.8) to 0.8 (0.4, 1.5), p = 0.013 between visits. No significant differences were observed in glucose tolerance, glucose area under the curve, nor fsOGTT glucose concentrations before and after ETI. Median (IQR) C-peptide index increased from 5.7 (4.1, 8.3) to 8.8 (5.5, 10.8) p = 0.013 and HOMA2 IR increased (p < 0.001), while oDIcoeo was unchanged (p = 0.67). HbA1c decreased from 5.5 % (5.5, 5.8) to 5.4 % (5.2, 5.6) (p = 0.003) while CGM variables did not change. Conclusions BMI z-score and measures of both insulin resistance and insulin secretion increased within the first year of ETI initiation. β-cell function adjusted for insulin sensitivity (oDIcoeo) did not change.
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Affiliation(s)
- Christine L. Chan
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrea Granados
- Department of Pediatrics, Nicklaus Children’s Hospital, Miami, FL, USA
| | - Amir Moheet
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sachinkumar Singh
- Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
| | - Timothy Vigers
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Yaling Yi
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA, USA
| | - Shanming Hu
- Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
| | - Andrew W. Norris
- Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA
| | - Katie Larson Ode
- Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA
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23
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Ode KL, Ballman M, Battezzati A, Brennan A, Chan CL, Hameed S, Ismail HM, Kelly A, Moran AM, Rabasa-Lhoret R, Saxby NA, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Management of cystic fibrosis-related diabetes in children and adolescents. Pediatr Diabetes 2022; 23:1212-1228. [PMID: 36537525 PMCID: PMC10108242 DOI: 10.1111/pedi.13453] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Katie Larson Ode
- University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Manfred Ballman
- University Medicine Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status, DeFENS, University of Milan, Milan, Italy
| | - Amanda Brennan
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christine L Chan
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shihab Hameed
- Sydney Children's Hospital, Randwick and Royal North Shore Hospital, St. Leonards, New South Wales, Australia.,School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Pediatric Endocrinology, University of Sydney, Camperdown, Australia
| | - Heba M Ismail
- Department of Pediatrics, Pediatric Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Kelly
- Department of Pediatrics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Endocrinology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Antoinette M Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Remi Rabasa-Lhoret
- Division of Experiemental Medicine, Montreal Clinical Research institute, Montreal, Canada
| | - Nichole A Saxby
- Women's and Children's Services, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Maria E Craig
- The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of NSW, Sydney, New South Wales, Australia
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24
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Wilschanski M, Peckham D. Nutritional and metabolic management for cystic fibrosis in a post-cystic fibrosis transmembrane conductance modulator era. Curr Opin Pulm Med 2022; 28:577-583. [PMID: 36102602 DOI: 10.1097/mcp.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The introduction of highly effective cystic fibrosis transmembrane conductance regulator modulators has resulted in a paradigm shift towards treating underlying cause of cystic fibrosis (CF) rather than the ensuing complications. In this review, we will describe the impact of these small molecules on growth, nutrition, and metabolic status in people with CF (pwCF). RECENT FINDING Results of clinical trials and real world data demonstrate that these small molecules are having a significant impact of on augmenting body weight, improving nutritional status and reducing gastrointestinal symptom burden. Early treatment can also positively impact on pancreatic endocrine and exocrine function. SUMMARY Nutritional and metabolic management of pwCF needs to change in order to maximize long term health and avoid future complications relating to obesity and increased cardiovascular risk. Longitudinal registry studies will be key to improve our understanding of the longer-term outcome of these new therapies.
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Affiliation(s)
- Michael Wilschanski
- Pediatric Gastroenterology Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Daniel Peckham
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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25
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Yaacoby-Bianu K, Schnapp Z, Koren I, Ilivitzki A, Khatib M, Shorbaji N, Shteinberg M, Livnat G. Real life evaluation of the multi-organ effects of Lumacaftor/Ivacaftor on F508del homozygous cystic fibrosis patients. BMC Pharmacol Toxicol 2022; 23:80. [PMID: 36266606 PMCID: PMC9585743 DOI: 10.1186/s40360-022-00624-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lumacaftor/Ivacaftor (LUM-IVA), a cystic fibrosis transmembrane conductance regulator (CFTR) protein corrector-potentiator combination, improves lung function and reduces pulmonary exacerbations (PEx) in F508del homozygous CF patients. However, the systemic effects of LUM-IVA outside the respiratory system have not yet been thoroughly investigated. METHODS A prospective, real-world, yearlong study was performed on F508del homozygous adult CF patients who commenced treatment with LUM-IVA. Pancreatic function, bone metabolism, fertility status, nutritional and pulmonary factors were evaluated. RESULTS Twelve patients, mean age 28.3 years (18.6-43.9) were recruited. Following 12 months of treatment, no changes were detected in glucose, insulin, c-peptide or BMI values. A significant relative decrease in mean alkaline-phosphatase levels (122.8 U/L vs 89.4, p = 0.002) and a trend toward an increase in calcium levels (9.5 vs 9.9 mg/dL, p = 0.074) were observed. A non-significant improvement in mean DEXA spine t-score after a year of treatment (-2.1 vs -1.6, n = 4, p = 0.11) was detected. Sweat chloride concentrations decreased significantly (-21.4 mEq/L; p = 0.003). Pulmonary outcome revealed improvement in spirometry values during the first three months (FEV1 by 5.7% p = 0.009, FEF25-75 by 4.3% p = 0.001) with no change in chest CT Bhalla score and CFQR after one year. There was also a significant decrease in parenteral antibiotic events (17 vs 8, p = 0.039) with shift from IV to oral antibiotics for PEx treatment. CONCLUSIONS After one year of treatment, stabilization was observed in the pancreatic indices, nutritional status, structure and function of the lungs, with a beneficial effect on bone mineral metabolism and CFTR function. Additional studies should investigate the effect of CFTR modulators on extra-pulmonary manifestations.
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Affiliation(s)
- Karin Yaacoby-Bianu
- Pediatric Pulmonology Unit and CF Center, Carmel Medical Center, 7 Michal St, 3436212, Haifa, Israel.,B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Zeev Schnapp
- B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| | - Ilana Koren
- B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Pediatric Endocrinology Unit, Carmel Medical Center, Haifa, Israel
| | - Anat Ilivitzki
- B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Mohamed Khatib
- B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Nadeem Shorbaji
- B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Michal Shteinberg
- B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
| | - Galit Livnat
- Pediatric Pulmonology Unit and CF Center, Carmel Medical Center, 7 Michal St, 3436212, Haifa, Israel. .,B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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Crow H, Bengtson C, Shi X, Graves L, Anabtawi A. CGM patterns in adults with cystic fibrosis-related diabetes before and after elexacaftor-tezacaftor-ivacaftor therapy. J Clin Transl Endocrinol 2022; 30:100307. [PMID: 36217440 PMCID: PMC9547287 DOI: 10.1016/j.jcte.2022.100307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/15/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis that is associated with worse outcomes and higher mortality rates. CF transmembrane conductance regulator gene (CFTR) modulators have shown favorable effects on lung function, pulmonary exacerbations, and nutrition status. However, data regarding effects of CFTR modulators on glycemic control among those with CFRD is lacking. In this retrospective study, CGM data was analyzed to determine effect of elexacaftortezacaftor- ivacaftor therapy (ETI), a CFTR modulator, on glucose control among patients with CFRD. No difference was seen in glucose patterns after 3- and 6- months of starting ETI.
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Affiliation(s)
- Hanna Crow
- University of Kansas Medical Center, Department of Internal Medicine, Division of Endocrinology, Metabolism & Clinical Pharmacology, 4000 Cambridge Blvd, Kansas City, KS 66160, USA
| | - Charles Bengtson
- University of Kansas Medical Center, Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 4000 Cambridge Blvd, Kansas City, KS 66160, USA
| | - Xiaosong Shi
- University of Kansas Medical Center, Department of Biostatistics & Data Science, 4000 Cambridge Blvd, Kansas City, KS 66160, USA
| | - Leland Graves
- University of Kansas Medical Center, Department of Internal Medicine, Division of Endocrinology, Metabolism & Clinical Pharmacology, 4000 Cambridge Blvd, Kansas City, KS 66160, USA
| | - Abeer Anabtawi
- University of Kansas Medical Center, Department of Internal Medicine, Division of Endocrinology, Metabolism & Clinical Pharmacology, 4000 Cambridge Blvd, Kansas City, KS 66160, USA,Corresponding author.
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Hasan S, Khan MS, Lansang MC. The effect of cystic fibrosis transmembrane conductance regulator modulators on impaired glucose tolerance and cystic fibrosis related diabetes. J Clin Transl Endocrinol 2022; 29:100301. [PMID: 35746945 PMCID: PMC9209718 DOI: 10.1016/j.jcte.2022.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/14/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive disorder, with a prevalence of 1 in 2,500 live births. It is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. With the significant advancement in CFTR-directed therapies, life expectancy of CF patients has steadily increased. With improved survival, CF related co-morbidities have become more apparent. The most common endocrine complication includes Cystic fibrosis related diabetes (CFRD). Impaired glucose tolerance and insulin deficiency in CFRD leads to a decline in pulmonary function in CF patients. Here we review the underlying mechanisms involved in the pathogenesis of CFRD, focusing on the role of CFTR in the regulation of insulin secretion from the β-cell. We then discuss CFTR modulators and their effect on impaired glucose tolerance and CFRD.
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Affiliation(s)
- Sana Hasan
- Department of Endocrinology and Metabolism, USA Cleveland Clinic Foundation, Cleveland, OH, USA
- Corresponding author.
| | | | - M. Cecilia Lansang
- Department of Endocrinology and Metabolism, USA Cleveland Clinic Foundation, Cleveland, OH, USA
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28
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Current state of CFTR modulators for treatment of Cystic Fibrosis. Curr Opin Pharmacol 2022; 65:102239. [DOI: 10.1016/j.coph.2022.102239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 12/23/2022]
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Impact of CFTR Modulators on Beta-Cell Function in Children and Young Adults with Cystic Fibrosis. J Clin Med 2022; 11:jcm11144149. [PMID: 35887914 PMCID: PMC9319690 DOI: 10.3390/jcm11144149] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/30/2022] [Accepted: 07/09/2022] [Indexed: 02/05/2023] Open
Abstract
Background: To date, no consistent data are available on the possible impact of CFTR modulators on glucose metabolism. The aim of this study was to test the hypothesis that treatment with CFTR modulators is associated with an improvement in the key direct determinants of glucose regulation in children and young adults affected by Cystic Fibrosis (CF). Methods: In this study, 21 CF patients aged 10–25 underwent oral glucose tolerance test (OGTT) before and after 12–18 months of treatment with Lumacaftor/Ivacaftor or Elexacaftor-Ivacaftor-Tezacaftor. β-cell function (i.e., first and second phase of insulin secretion measured as derivative and proportional control, respectively) and insulin clearance were estimated by OGTT mathematical modelling. Insulin sensitivity was estimated by the Oral Glucose Sensitivity Index (OGIS). The dynamic interplay between β-cell function, insulin clearance and insulin sensitivity was analysed by vector plots of glucose-stimulated insulin bioavailability vs. insulin sensitivity. Results: No changes in glucose tolerance occurred after either treatment, whereas a significant improvement in pulmonary function and chronic bacterial infection was observed. Beta cell function and insulin clearance did not change in both treatment groups. Insulin sensitivity worsened in the Lumacaftor/Ivacaftor group. The analysis of vector plots confirmed that glucose regulation was stable in both groups. Conclusions: Treatment of CF patients with CFTR modulators does not significantly ameliorate glucose homeostasis and/or any of its direct determinants.
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Rakotoarisoa L, Weiss L, Lefebvre F, Porzio M, Ravoninjatovo B, Abely M, Boucher ID, Dubois S, Troussier F, Gilles R, Prevotat A, Kessler L. Comparison of Continuous Glucose Monitoring in Cystic Fibrosis Patients With or Without Pancreatic Exocrine Insufficiency. Horm Metab Res 2022; 54:407-412. [PMID: 35272389 DOI: 10.1055/a-1794-5496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This study aimed to compare continuous glucose monitoring (CGM) in cystic fibrosis (CF) according to pancreatic exocrine status.CGM and oral glucose tolerance testing (OGTT) were realized annually over five years in people with CF (pwCF) aged≥10 years without cystic fibrosis-related diabetes (CFRD). CGM parameters in patients with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and newly diagnosed CFRD were compared according to presence of pancreatic sufficiency (PS) or insufficiency (PI).Overall, 547 OGTTs and 501 CGMs were performed in 147 CF patients, comprising 122 PI and 25 PS. In PS patients, 84% displayed NGT, 12% IGT, and 4% CFRD vs. 58%, 32%, and 10% (p=0.05) in PI. Among participants displaying normal OGTT, time in glucose range (70-140 mg/dl) was significantly increased, 97% (93, 99) vs. 92% (85, 96), p<0.001, and time above glucose range > 140 mg/dl significantly decreased, 1% (0, 2) % vs. 6% (2, 13), in patients with PS compared to those with PI. No significant differences were highlighted in patients with IGT.CGM revealed significant different glucose tolerance abnormalities in PI versus PS, which were undetected by standard 2-hour OGTT glucose.
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Affiliation(s)
- Luc Rakotoarisoa
- Department of Diabetology, University Hospital Strasbourg, Strasbourg, France
- Inserm UMR 1260, Regenerative Nanomedicine, University of Strasbourg, Strasbourg, France
| | - Laurence Weiss
- CRCM, University Hospital Strasbourg, Strasbourg, France
| | | | - Michele Porzio
- CRCM, University Hospital Strasbourg, Strasbourg, France
| | | | - Michel Abely
- CRCM, University Hospital Centre Reims, Reims, France
| | | | - Séverine Dubois
- Diabetology, University Hospital Centre Angers, Angers, France
| | | | | | - Anne Prevotat
- Allergology, Lille University Hospital Center, Lille, France
| | - Laurence Kessler
- Department of Diabetology, University Hospital Strasbourg, Strasbourg, France
- Inserm UMR 1260, Regenerative Nanomedicine, University of Strasbourg, Strasbourg, France
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Balfour-Lynn IM, King JA. CFTR modulator therapies - Effect on life expectancy in people with cystic fibrosis. Paediatr Respir Rev 2022; 42:3-8. [PMID: 32565113 PMCID: PMC7255286 DOI: 10.1016/j.prrv.2020.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
CFTR modulators have dramatically changed the clinical course of CF in those fortunate enough to receive them. Inevitably, randomised controlled trials during the development of these drugs are too short to use mortality as an outcome. Evidence for their effect on life expectancy are best gained from real world registry studies specifically looking at mortality, but these are only available for ivacaftor to date. Therefore, indirect evidence must be obtained by looking at outcomes known to affect mortality and seeing the effect of these drugs on those outcomes.
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Affiliation(s)
- I M Balfour-Lynn
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.
| | - J A King
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
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Regard L, Martin C, Burnet E, Da Silva J, Burgel PR. CFTR Modulators in People with Cystic Fibrosis: Real-World Evidence in France. Cells 2022; 11:cells11111769. [PMID: 35681464 PMCID: PMC9179538 DOI: 10.3390/cells11111769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 01/18/2023] Open
Abstract
Cystic fibrosis (CF) is a rare genetic multisystemic disease, the manifestations of which are due to mutations in the gene encoding the CF transmembrane conductance regulator (CFTR) protein and can lead to respiratory insufficiency and premature death. CFTR modulators, which were developed in the past decade, partially restore CFTR protein function. Their clinical efficacy has been demonstrated in phase 3 clinical trials, particularly in terms of lung function and pulmonary exacerbations, nutritional status, and quality of life in people with gating mutations (ivacaftor), homozygous for the F508del mutation (lumacaftor/ivacaftor and tezacaftor/ivacaftor), and in those with at least one F508del mutation (elexacaftor/tezacaftor/ivacaftor). However, many questions remain regarding their long-term safety and effectiveness, particularly in patients with advanced lung disease, liver disease, renal insufficiency, or problematic bacterial colonization. The impact of CFTR modulators on other important outcomes such as concurrent treatments, lung transplantation, chest imaging, or pregnancies also warrants further investigation. The French CF Reference Network includes 47 CF centers that contribute patient data to the comprehensive French CF Registry and have conducted nationwide real-world studies on CFTR modulators. This review seeks to summarize the results of these real-world studies and examine their findings against those of randomized control trials.
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Affiliation(s)
- Lucile Regard
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- Institut Cochin, Université de Paris Cité, INSERM U1016, 75014 Paris, France
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Clémence Martin
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- Institut Cochin, Université de Paris Cité, INSERM U1016, 75014 Paris, France
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Espérie Burnet
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- Institut Cochin, Université de Paris Cité, INSERM U1016, 75014 Paris, France
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Jennifer Da Silva
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Pierre-Régis Burgel
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- Institut Cochin, Université de Paris Cité, INSERM U1016, 75014 Paris, France
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
- Correspondence: ; Tel.: +33-1-58-41-23-67; Fax: +33-1-46-33-82-53
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Merjaneh L, Hasan S, Kasim N, Ode KL. The role of modulators in cystic fibrosis related diabetes. J Clin Transl Endocrinol 2022; 27:100286. [PMID: 34917484 PMCID: PMC8668978 DOI: 10.1016/j.jcte.2021.100286] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 11/21/2022] Open
Abstract
The development and introduction of modulator therapies have completely shifted the paradigm for the treatment of cystic fibrosis (CF). Highly effective modulator therapies have driven marked improvements in lung function, exacerbation rate, weight and quality of life in CF patients. However, their effect on CF related diabetes (CFRD) is not well delineated. The role of CF transmembrane conductance regulator (CFTR) in CFRD pathogenesis is inadequately understood and research aimed at deciphering the underlying mechanisms of CFRD continues to evolve. In this review, we summarize what is known regarding the effect of CFTR modulators on CFRD. Small studies using ivacaftor monotherapy in gating mutations have revealed improvement in insulin secretion, glucose tolerance and/or decrease in insulin requirement. However, lumacaftor/ivacaftor studies (primarily in delta F 508 homozygous) have not revealed significant improvement in CFRD or glucose tolerance. No studies are yet available regarding the effect of the highly effective triple therapy (elexacaftor/tezacaftor/ivacaftor) on CFRD or insulin secretion. CFTR modulators might affect development or progression of CFRD through many mechanisms including improving insulin secretion by correcting the CFTR defect directly, improving ductal function, reducing islet inflammation, and improving incretin secretion or by enhancing insulin sensitivity via reduced systemic inflammation and increased physical activity driven by improved lung function and quality of life. On the other hand, they can stimulate appetite and improve gastrointestinal function resulting in increased caloric intake and absorption, driving excessive weight gain and potentially increased insulin resistance. If the defect in insulin secretion is reversible then it is possible that initiation of CFTR modulators at a younger age might help prevent CFRD. Despite the advances in CF management, CFRD remains a challenge and knowledge continues to evolve. Future studies will drive better understanding of the role of highly effective CFTR modulators in CFRD.
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Affiliation(s)
- Lina Merjaneh
- Division of Endocrinology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Sana Hasan
- Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, OH
| | - Nader Kasim
- Division of Pediatric Diabetes and Endocrinology, Helen Devos Children’s Hospital, Spectrum Health, Grand Rapids, MI, USA
| | - Katie Larson Ode
- Division of Endocrinology, Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
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Scully KJ, Marchetti P, Sawicki GS, Uluer A, Cernadas M, Cagnina RE, Kennedy JC, Putman MS. The effect of elexacaftor/tezacaftor/ivacaftor (ETI) on glycemia in adults with cystic fibrosis. J Cyst Fibros 2022; 21:258-263. [PMID: 34531155 PMCID: PMC8918034 DOI: 10.1016/j.jcf.2021.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cystic fibrosis related diabetes (CFRD) is associated with pulmonary decline and compromised nutritional status. Emerging data suggest that CFTR dysfunction may play a direct role in the pathogenesis of CFRD; however, studies investigating the effect of CFTR modulators on glycemic outcomes in patients with cystic fibrosis (CF) have shown mixed results. The impact of elexacaftor-tezacaftor-ivacaftor (ETI) on glycemic control is currently unknown. Our objective was to investigate the effect of ETI initiation on glycemia in adults with CF using continuous glucose monitoring (CGM). METHODS In this prospective observational study, 34 adults with CF and at least one F508del CFTR mutation wore CGM sensors for 14 days prior to starting ETI and again 3-12 months after ETI initiation. Hypoglycemia symptoms were queried at each visit, and most recent anthropometric measures and spirometry data were obtained by chart review. RESULTS Twenty-three participants completed the study. Compared to baseline, average glucose (AG), standard deviation (SD), % time >200 mg/dL, and peak sensor glucose decreased with ETI treatment, and % time in target range 70-180 mg/dL increased. Improvements in glycemic parameters were most notable in individuals with CFRD. There was no significant change in CGM-measured or self-reported hypoglycemia before and after ETI initiation. CONCLUSION Initiation of ETI in adults with CF was associated with improvement CGM-derived measures of hyperglycemia and glycemic variability with no effect on hypoglycemia. Further studies are needed to investigate underlying etiology of these changes and the long-term impact of ETI on glycemic control in patients with CF.
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Affiliation(s)
- Kevin J Scully
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, Harvard Medical School, Boston MA
| | - Peter Marchetti
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA
| | - Gregory S. Sawicki
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA
| | - Ahmet Uluer
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston MA
| | - Manuela Cernadas
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston MA
| | - Rebecca E. Cagnina
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston MA
| | - John C. Kennedy
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston MA
| | - Melissa S. Putman
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, Harvard Medical School, Boston MA, Diabetes Research Center, Massachusetts General Hospital, Boston, MA
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Korten I, Kieninger E, Krueger L, Bullo M, Flück CE, Latzin P, Casaulta C, Boettcher C. Short-Term Effects of Elexacaftor/Tezacaftor/Ivacaftor Combination on Glucose Tolerance in Young People With Cystic Fibrosis-An Observational Pilot Study. Front Pediatr 2022; 10:852551. [PMID: 35529332 PMCID: PMC9070552 DOI: 10.3389/fped.2022.852551] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effect of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) on glucose tolerance and/or cystic-fibrosis-related diabetes (CFRD) is not well understood. We performed an observational study on the short-term effects of ELX/TEZ/IVA on glucose tolerance. METHODS Sixteen adolescents with CF performed oral glucose tolerance tests (OGTT) before and 4-6 weeks after initiating ELX/TEZ/IVA therapy. A continuous glucose monitoring (CGM) system was used 3 days before until 7 days after starting ELX/TEZ/IVA treatment. RESULTS OGTT categories improved after initiating ELX/TEZ/IVA therapy (p = 0.02). Glucose levels of OGTT improved at 60, 90, and 120 min (p < 0.05), whereas fasting glucose and CGM measures did not change. CONCLUSION Shortly after initiating ELX/TEZ/IVA therapy, glucose tolerance measured by OGTT improved in people with CF. This pilot study indicates that ELX/TEZ/IVA treatment has beneficial effects on the endocrine pancreatic function and might prevent or at least postpone future CFRD.
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Affiliation(s)
- Insa Korten
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elisabeth Kieninger
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Linn Krueger
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marina Bullo
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christa E Flück
- Department of Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of BioMedical Research, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Boettcher
- Department of Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of BioMedical Research, Bern University Hospital, University of Bern, Bern, Switzerland
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Goetz DM, Savant AP. Review of CFTR modulators 2020. Pediatr Pulmonol 2021; 56:3595-3606. [PMID: 34407318 DOI: 10.1002/ppul.25627] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/21/2022]
Abstract
Cystic fibrosis transmembrane conductance regulator (CFTR) modulators are small molecules that directly impact the CFTR protein, improving the function of the CFTR chloride and bicarbonate channel. Beginning in 2012 with the Food and Drug Administration approval of the first CFTR modulator, ivacaftor, this class of medications has had largely positive effects on many outcomes in people with cystic fibrosis (PwCF), including lung function, growth, and other clinical parameters. There have been continued exciting developments in the current research on CFTR modulators, expanding beyond original studies. This first part of a three-part cystic fibrosis (CF) year in review 2020 will focus on research on CFTR modulators. In addition to reviewing new clinical insights, we describe work done on novel outcomes, adverse effects, issues related to cost, and next steps for clinical trials. The review focuses on articles from Pediatric Pulmonology published in 2020, but it includes articles from other journals that are of particular interest to clinicians. New developments in CF research continue to be brought forth to the CF community, deepening the understanding of this disease and improving clinical care.
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Affiliation(s)
- Danielle M Goetz
- Department of Pediatrics, University at Buffalo School of Medicine, New York, New York, USA
| | - Adrienne P Savant
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Colombo C, Foppiani A, Bisogno A, Gambazza S, Daccò V, Nazzari E, Leone A, Giana A, Mari A, Battezzati A. Lumacaftor/ivacaftor in cystic fibrosis: effects on glucose metabolism and insulin secretion. J Endocrinol Invest 2021; 44:2213-2218. [PMID: 33586024 PMCID: PMC8421269 DOI: 10.1007/s40618-021-01525-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/30/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE The question whether the new cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs aimed at restoring CFTR protein function might improve glucose metabolism is gaining attention, but data on the effect of lumacaftor/ivacaftor treatment (LUMA/IVA) on glucose tolerance are limited. We evaluated the variation in glucose metabolism and insulin secretion in CF patients homozygous for Phe508del CFTR mutation after one-year treatment with LUMA/IVA in comparison to patients with the same genotype who did not receive such treatment. METHODS We performed a retrospective case-control study on 13 patients with a confirmed diagnosis of CF, homozygous for the Phe508del CFTR mutation, who received LUMA/IVA for one year (cases) and 13 patients with identical genotype who did not receive this treatment (controls). At the beginning and conclusion of the follow-up, all subjects received a modified 3 h OGTT, sampling at baseline, and at 30 min intervals for plasma glucose, serum insulin, and c-peptide concentrations to evaluate glucose tolerance, and quantify by modeling beta-cell insulin secretion responsiveness to glucose, insulin clearance and insulin sensitivity. RESULTS LUMA/IVA did not produce differences in glucose tolerance, insulin secretory parameters, clearance and sensitivity with respect to matched controls over one-year follow-up. CONCLUSION We found no evidence of improvements in glucose tolerance mechanisms in patients with CF after one-year treatment with LUMA/IVA.
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Affiliation(s)
- C Colombo
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - A Foppiani
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - A Bisogno
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - S Gambazza
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
- Direzione delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Daccò
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - E Nazzari
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - A Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - A Giana
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A Mari
- National Research Council (CNR), Institute of Neuroscience, Padua, Italy
| | - A Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
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Prentice BJ, Jaffe A, Hameed S, Verge CF, Waters S, Widger J. Cystic fibrosis-related diabetes and lung disease: an update. Eur Respir Rev 2021; 30:30/159/200293. [PMID: 33597125 PMCID: PMC9488640 DOI: 10.1183/16000617.0293-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
The development of cystic fibrosis-related diabetes (CFRD) often leads to poorer outcomes in patients with cystic fibrosis including increases in pulmonary exacerbations, poorer lung function and early mortality. This review highlights the many factors contributing to the clinical decline seen in patients diagnosed with CFRD, highlighting the important role of nutrition, the direct effect of hyperglycaemia on the lungs, the immunomodulatory effects of high glucose levels and the potential role of genetic modifiers in CFRD.
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Affiliation(s)
- Bernadette J Prentice
- Dept of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
| | - Adam Jaffe
- Dept of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
| | - Shihab Hameed
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
- Dept of Endocrinology, Sydney Children's Hospital, Randwick, Australia
| | - Charles F Verge
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
- Dept of Endocrinology, Sydney Children's Hospital, Randwick, Australia
| | - Shafagh Waters
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
- MiCF Research Centre, Sydney, Australia
| | - John Widger
- Dept of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
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Gbian DL, Omri A. Current and novel therapeutic strategies for the management of cystic fibrosis. Expert Opin Drug Deliv 2021; 18:535-552. [PMID: 33426936 DOI: 10.1080/17425247.2021.1874343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Cystic fibrosis (CF), is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and affects thousands of people throughout the world. Lung disease is the leading cause of death in CF patients. Despite the advances in treatments, the management of CF mainly targets symptoms. Recent CFTR modulators however target common mutations in patients, alleviating symptoms of CF. Unfortunately, there is still no approved treatments for patients with rare mutations to date.Areas covered: This paper reviews current treatments of CF that mitigate symptoms and target genetic defects. The use of gene and drug delivery systems such as viral or non-viral vectors and nano-compounds to enhance CFTR expression and the activity of antimicrobials against chronic pulmonary infections respectively, will also be discussed.Expert opinion: Nano-compounds tackle biological barriers to drug delivery and revitalize antimicrobials, anti-inflammatory drugs and even genes delivery to CF patients. Gene therapy and gene editing are of particular interest because they have the potential to directly target genetic defects. Nanoparticles should be formulated to more specifically target epithelial cells, and biofilms. Finally, the development of more potent gene vectors to increase the duration of gene expression and reduce inflammation is a promising strategy to eventually cure CF.
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Affiliation(s)
- Douweh Leyla Gbian
- The Novel Drug and Vaccine Delivery Systems Facility, Department of Chemistry and Biochemistry, Laurentian University, Sudbury, Ontario, Canada
| | - Abdelwahab Omri
- The Novel Drug and Vaccine Delivery Systems Facility, Department of Chemistry and Biochemistry, Laurentian University, Sudbury, Ontario, Canada
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Moheet A, Beisang D, Zhang L, Sagel SD, VanDalfsen JM, Heltshe SL, Frederick C, Mann M, Antos N, Billings J, Rowe SM, Moran A. Lumacaftor/ivacaftor therapy fails to increase insulin secretion in F508del/F508del CF patients. J Cyst Fibros 2020; 20:333-338. [PMID: 32917547 DOI: 10.1016/j.jcf.2020.09.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/13/2020] [Accepted: 09/02/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Glucose tolerance abnormalities including cystic fibrosis related diabetes (CFRD) are common in patients with cystic fibrosis (CF). The underlying pathophysiology is not fully understood. Emerging evidence suggests that CFTR dysfunction may directly or indirectly impact β-cell function, offering the potential for improvement with CFTR modulator therapy. In small pilot studies, treatment with ivacaftor improved insulin secretion in patients with the G551D CFTR mutation. In the current study, we examined the impact of lumacaftor/ivacaftor therapy on glucose tolerance and insulin secretion in patients with CF who were homozygous for the F508del mutation. METHODS 39 subjects from the PROSPECT Part B study who had been prescribed lumacaftor/ivacaftor by their CF care team at a CF Foundation's Therapeutic Development Network center were recruited. Subjects underwent 2-hour oral glucose tolerance tests (OGTTs) at baseline prior to first dose of lumacaftor/ivacaftor, and at 3, 6 and 12 months on therapy. OGTT glucose, insulin and c-peptide parameters were compared. RESULTS Compared to baseline, OGTT fasting and 2 hour glucose levels, glucose area under the curve, insulin area under the curve and time to peak insulin level were not significantly different at 3, 6 and 12 months on lumacaftor/ivacaftor therapy. Similarly, C-peptide levels were no different. CONCLUSIONS Lumacaftor/ivacaftor therapy did not improve insulin secretion or glucose tolerance in patients with CF who were homozygous for the F508del mutation.
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Affiliation(s)
- Amir Moheet
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Daniel Beisang
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Scott D Sagel
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado Anshutz Medical Campus, Aurora, CO, United States
| | - Jill M VanDalfsen
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle, Children's Research, Seattle, WA, United States
| | - Sonya L Heltshe
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle, Children's Research, Seattle, WA, United States; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Carla Frederick
- Jacobs School of Medicine and Biomedical Sciences of the University at Buffalo and UBMD Internal Medicine, Buffalo, NY, United States
| | - Michelle Mann
- Baylor College of Medicine, Houston, TX, United States
| | - Nicholas Antos
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joanne Billings
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Steven M Rowe
- Department of Medicine and the Gregory Flemming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.
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Chan CL. Cystic fibrosis related diabetes: Revisiting the OGTT and alternate screening tests. J Cyst Fibros 2020; 19:671-672. [DOI: 10.1016/j.jcf.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kessler L. Can lumacaftor-ivacaftor reverse glucose-tolerance abnormalities in cystic fibrosis? J Cyst Fibros 2020; 19:666. [DOI: 10.1016/j.jcf.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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