1
|
Lehoux Dubois C, Boudreau V, Potter KJ, Colomba J, Lavoie A, Mailhot M, Desjardins K, Rabasa-Lhoret R. Acute soluble fibre supplementation has no impact on reducing post-prandial glucose excursions in adults with cystic fibrosis and glucose intolerance. ANNALES D'ENDOCRINOLOGIE 2023; 84:767-772. [PMID: 36764386 DOI: 10.1016/j.ando.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Cystic fibrosis (CF)-related diabetes (CFRD) is a common comorbidity in CF. In CFRD, fasting blood glucose level is often normal, but post-prandial glycaemia (PPG) is problematic. Elevated PPG has been associated to a higher risk of developing CFRD, a worst clinical state and a lower pulmonary function. Interventional studies in type 2 diabetes have demonstrated a beneficial impact of fibre supplement on PPG. METHODS Our objective is to evaluate the efficiency of 2 doses of a soluble fibre supplement to lower PPG in CF patients with glucose intolerance (pre-diabetic or CFRD patients). This is a double-blinded crossover interventional study with three interventions: placebo or psyllium fibre (5.1g or 7.7g) of soluble fibre consumed before breakfast. A second meal (lunch) is also eaten four hours later to evaluate a second meal effect. Blood glucose and insulin were measured during the interventions. RESULTS In 14 adult CF patients with impaired glucose tolerance (IGT; n=10) or CFRD (n=4), we observed no beneficial effect of fibre supplementation on PPG for both meals. However, all blood glucose levels were lower after the lunch compared to breakfast in spite of the higher carbohydrate content. CONCLUSION An acute treatment with fibre supplementation had no effect on blood glucose control in patients with CF-IGT or CFRD.
Collapse
Affiliation(s)
- Catherine Lehoux Dubois
- Institut de recherches cliniques de Montréal, Montréal, Québec H2W 1R7, Canada; Department of Nutrition, université de Montréal, Montréal, Québec H3T 1A8, Canada
| | - Valérie Boudreau
- Institut de recherches cliniques de Montréal, Montréal, Québec H2W 1R7, Canada; Department of Nutrition, université de Montréal, Montréal, Québec H3T 1A8, Canada
| | - Kathryn J Potter
- Institut de recherches cliniques de Montréal, Montréal, Québec H2W 1R7, Canada
| | - Johann Colomba
- Institut de recherches cliniques de Montréal, Montréal, Québec H2W 1R7, Canada; Department of Nutrition, université de Montréal, Montréal, Québec H3T 1A8, Canada
| | - Annick Lavoie
- Cystic fibrosis clinic of the centre hospitalier de l'université de Montréal, Montréal, Québec H2W 1T8, Canada
| | - Marjolaine Mailhot
- Cystic fibrosis clinic of the centre hospitalier de l'université de Montréal, Montréal, Québec H2W 1T8, Canada
| | - Katherine Desjardins
- Institut de recherches cliniques de Montréal, Montréal, Québec H2W 1R7, Canada; Department of Nutrition, université de Montréal, Montréal, Québec H3T 1A8, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, Québec H2W 1R7, Canada; Department of Nutrition, université de Montréal, Montréal, Québec H3T 1A8, Canada; Department of Medecine, université de Montréal, Montréal, Québec H3T 1J4, Canada; Cystic fibrosis clinic of the centre hospitalier de l'université de Montréal, Montréal, Québec H2W 1T8, Canada.
| |
Collapse
|
2
|
Prentice BJ, Potter KJ, Coriati A, Boudreau V, Rusnell L, Kherani T, Senior PA, Hameed S, Rabasa-Lhoret R. Cystic Fibrosis-Related Diabetes: Clinical approach and knowledge gaps. Paediatr Respir Rev 2022:S1526-0542(22)00067-7. [PMID: 36376223 DOI: 10.1016/j.prrv.2022.10.001] [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: 08/10/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Cystic Fibrosis-Related Diabetes (CFRD) is a unique type of diabetes mellitus that shares some features with both type 1 and type 2 diabetes. Yet, its distinguishing feature of acute pulmonary complications associated with hyperglycemia and the catabolic metabolism associated with a relative insulin deficiency poses challenges to the application of traditional definitions and treatments for diabetes mellitus. People with CF (pwCF) undergo rigorous annual screening starting at age 10, a process that is challenging for patients and limited by sensitivity, specificity, and reproducibility. As pwCF continue to live longer, over 50% are expected to develop CFRD over their lifetime, including up to 20% of adolescents. Increasing numbers of people with CFRD will make this disease increasingly relevant to diabetes practitioners. Evidence-guided practice in CFRD care is limited by small and short studies. Our current understanding of CFRD may change significantly with the recent introduction of CF Transmembrane Regulator (CFTR) modulator medications. This review will explore current challenges in the diagnosis and management of CFRD, specifically highlighting knowledge gaps in the pathophysiology of CFRD, optimal screening methods, priorities for research and provide guidance with regards to screening, diagnosis, and treatment.
Collapse
Affiliation(s)
- Bernadette J Prentice
- Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Kathryn J Potter
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Adèle Coriati
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Valérie Boudreau
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Leah Rusnell
- Department of Pediatric Respirology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Tamizan Kherani
- Department of Pediatric Respirology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Peter A Senior
- Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - 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; Dept of Paediatric Endocrinology Royal North Shore Hospital, Sydney, Australia
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Division of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
| |
Collapse
|
3
|
Escudero García J, Martín Rivada Á, Uribe Posada A, Sanz Santiago V, Argente J, Martos-Moreno GÁ. Carbohydrate metabolism impairment in children and adolescents with cystic fibrosis. ENDOCRINOL DIAB NUTR 2022; 69:576-583. [PMID: 36347795 DOI: 10.1016/j.endien.2021.08.009] [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: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Development of cystic fibrosis-related diabetes (CFRD) is associated with worsening of nutritional status and lung function, as well as increased mortality. The relevance of diagnosing the «pre-diabetic» status in these patients has not been addressed and the utility of HbA1c measurement in these patients is under discussion. AIM To study and characterise the different categories of carbohydrate metabolism impairment in paediatric patients with cystic fibrosis. PATIENTS AND METHODS A transversal study for characterisation of carbohydrate metabolism impairment according to clinical and anthropometric status and genetic background in 50 paediatric patients with cystic fibrosis (CF) was undertaken. Oral glucose tolerance tests (OGTT) for determination of glucose and insulin levels measurement and continuous subcutaneous glucose monitoring (CSGM) were performed. RESULTS 6% of patients presented with CFRD, 26% impaired glucose tolerance, 10% an indeterminate glucose alteration and 2% impaired fasting glucose. The severity of glycaemic impairment correlated positively with age and negatively with standardised height (p < 0.05) with intergroup differences in HbA1c levels (p < 0.01), with the latter correlating with the duration of hyperglycaemia throughout CSGM. No intergroup differences in mutation prevalence, pulmonary function test, nutritional status or disease exacerbations in the previous year were found. The daily enzyme replacement dose correlated with the glucose area under the curve (AUC, p < 0.05) but not with insulin-AUC. CONCLUSIONS An older age and greater enzyme replacement need are correlated with more severe carbohydrate metabolism impairment and lower standardized height in paediatric CF patients, with HbA1c correlating with the duration of hyperglycaemia. The study of the full glucose/insulin AUCs throughout the OGTT affords no additional information compared to glucose determination at 120 min in these patients.
Collapse
Affiliation(s)
- Janire Escudero García
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
| | - Álvaro Martín Rivada
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
| | - Amalia Uribe Posada
- Sección de Neumología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Jesús Argente
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain
| | - Gabriel Ángel Martos-Moreno
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
4
|
Escudero García J, Martín Rivada Á, Uribe Posada A, Sanz Santiago V, Argente J, Martos-Moreno GÁ. Alteraciones del metabolismo hidrocarbonado en niños y adolescentes afectos de fibrosis quística. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
5
|
Khare S, Desimone M, Kasim N, Chan CL. Cystic fibrosis-related diabetes: Prevalence, screening, and diagnosis. J Clin Transl Endocrinol 2022; 27:100290. [PMID: 34917485 PMCID: PMC8669384 DOI: 10.1016/j.jcte.2021.100290] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Abstract
Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in patients with cystic fibrosis (CF). Prevalence of CFRD increases with age and is greater with severe mutations. Other risk factors associated with CFRD are female sex, pancreatic insufficiency, liver disease, need for gastrostomy tube feedings, history of bronchopulmonary aspergillosis, and poor pulmonary function. CFRD is related to worse clinical outcomes and increased mortality. Early diagnosis and treatment have been shown to improve clinical outcomes. Screening for CFRD is recommended with an annual oral glucose tolerance test (OGTT) starting at age 10 years. Diagnosis of CFRD is made by standard American Diabetes Association (ADA) criteria during baseline health. CFRD can also be diagnosed in individuals with CF during acute illness, while on enteral feeds, and after transplant. In this review we will discuss the epidemiology of CFRD and provide an overview of the advantages and pitfalls of current screening and diagnostic tests for CFRD.
Collapse
Affiliation(s)
- Swapnil Khare
- Division of Endocrinology, Diabetes and Metabolism, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Marisa Desimone
- Division of Endocrinology, Diabetes and Metabolism SUNY, Upstate Medical University, Syracuse, NY, United States
| | - Nader Kasim
- Division of Pediatric Endocrinology, Michigan State University, Helen Devos Children's Hospital/Spectrum Health, Grand Rapids, MI, United States
| | - Christine L. Chan
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
6
|
Poore TS, Taylor-Cousar JL, Zemanick ET. Cardiovascular complications in cystic fibrosis: A review of the literature. J Cyst Fibros 2021; 21:18-25. [PMID: 34140249 DOI: 10.1016/j.jcf.2021.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Abstract
Cystic fibrosis is a genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, leading to dysfunction of the CFTR protein. CFTR dysfunction leads to disease in the respiratory and gastrointestinal systems. Disorders of the cardiovascular system in individuals with CF are usually attributed to secondary effects from progressive lung disease. However, CFTR has been localized to vascular endothelium and smooth muscle, suggesting that CFTR dysfunction may directly impact cardiovascular function. As treatments for CF improve and life-expectancy increases, the risk of vascular disease may increase in prevalence related to primary and secondary CFTR dysfunction, chronic systemic inflammation, nutritional health and hyperglycemia in individuals with CF related diabetes. Here we review the available literature on CF and the cardiovascular system, examining the secondary effects and evidence for direct CFTR dysfunction in the heart, aorta, pulmonary vessels, and vasculature, as well as future directions and treatment options.
Collapse
Affiliation(s)
- T Spencer Poore
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Edith T Zemanick
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
7
|
Bonhoure A, Potter KJ, Colomba J, Boudreau V, Bergeron C, Desjardins K, Carricart M, Tremblay F, Lavoie A, Rabasa-Lhoret R. Peak glucose during an oral glucose tolerance test is associated with future diabetes risk in adults with cystic fibrosis. Diabetologia 2021; 64:1332-1341. [PMID: 33693987 DOI: 10.1007/s00125-021-05423-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/11/2021] [Indexed: 01/06/2023]
Abstract
AIMS/HYPOTHESIS Cystic fibrosis-related diabetes (CFRD) affects up to 50% of adults with cystic fibrosis (CF) and its presence is associated with adverse effects on nutritional status and pulmonary function. Early diagnosis could minimise CFRD morbidity, yet current methods of an OGTT at 0 and 2 h yield unreliable results. Our aim was to determine which indices from a 2 h OGTT with sampling every 30 min might improve prediction of CFRD. METHODS Cross-sectional analysis at baseline (n = 293) and observational prospective analysis (n = 185; mean follow-up of 7.5 ± 4.2 years) of the Montreal Cystic Fibrosis Cohort were performed. Blood glucose and insulinaemia OGTT variables were studied in relation to lung function (forced expiratory volume in 1 s [FEV1]), BMI and risk of developing CFRD. RESULTS At baseline, maximum OGTT glucose (Gmax) was negatively associated with FEV1 (p = 0.003). Other OGTT values, including classical 2 h glucose, were not. A higher Gmax was associated with lower insulin secretory capacity, delayed insulin peak timing and greater pancreatic insufficiency (p < 0.01). Gmax was positively associated with the risk of developing CFRD (p = 0.0029); no individual with a Gmax < 8 mmol/l developed CFRD over the following decade. No OGTT variable correlated to the rate of change in BMI or FEV1. CONCLUSIONS/INTERPRETATION In adults with CF, Gmax is strongly associated with the risk of developing CFRD; Gmax < 8 mmol/l could identify those at very low risk of future CFRD. Gmax is higher in individuals with pancreatic insufficiency and is associated with poorer insulin secretory capacity and pulmonary function.
Collapse
Affiliation(s)
- Anne Bonhoure
- Montreal Clinical Research Institute, Montreal, QC, Canada
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Johann Colomba
- Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Valérie Boudreau
- Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Cindy Bergeron
- Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Maïté Carricart
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Cystic Fibrosis Clinic, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - François Tremblay
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Cystic Fibrosis Clinic, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Annick Lavoie
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Cystic Fibrosis Clinic, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montreal, QC, Canada.
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
- Cystic Fibrosis Clinic, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada.
| |
Collapse
|
8
|
Chan CL, Ode KL, Granados A, Moheet A, Moran A, Hameed S. Continuous glucose monitoring in cystic fibrosis - A practical guide. J Cyst Fibros 2020; 18 Suppl 2:S25-S31. [PMID: 31679725 DOI: 10.1016/j.jcf.2019.08.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
Our ability to monitor blood glucose levels has become increasingly accurate over the last few decades. Continuous glucose monitoring (CGM) technology now allows providers and patients the ability to monitor glucose levels retrospectively as well as in real-time for diabetes management. CGM also provides the ability to study glucose patterns and trends for insight into the pathophysiology and natural history of disease. CGM captures a more complete picture of glucose profiles than traditional measures of glycemia such as the hemoglobin A1c or self-monitoring of blood glucose levels. This article provides a review of the history of glucose monitoring, a review of the literature pertaining to CGM with a focus on studies in patients with cystic fibrosis, and discusses practical uses of CGM technology and its application for the evaluation and management of cystic fibrosis related diabetes.
Collapse
Affiliation(s)
- Christine L Chan
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, 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
| | - Andrea Granados
- Department of Pediatrics, Washington University School of Medicine in St. Louis, MO, USA
| | - Amir Moheet
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Shihab Hameed
- University of New South Wales, Australia; Sydney Children's Hospital, Randwick, Australia; University of Sydney, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| |
Collapse
|
9
|
Colombo C, Alicandro G, Gambazza S, Mileto P, Mari A, Grespan E, Nazzari E, Russo MC, Battezzati A. Ventilation inhomogeneity is associated with OGTT-derived insulin secretory defects in cystic fibrosis. Pediatr Pulmonol 2019; 54:141-149. [PMID: 30575293 DOI: 10.1002/ppul.24212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/09/2018] [Indexed: 12/24/2022]
Abstract
Progressive deterioration of β-cell function is the main mechanism underlying diabetes in cystic fibrosis (CF). Diabetes negatively impacts the clinical status of CF patients years before its onset. We aimed to evaluate if OGTT-derived indices of β-cell function are associated with early markers of lung disease. We carried out a cross-sectional study on 80 CF patients who performed OGTT, spirometry, and nitrogen-multiple breath washout test. β-cell glucose sensitivity and the insulinogenic indices were used as markers of β-cell function and first-phase insulin response to glucose stimulus. We used sex- and age-adjusted multiple linear regression models to estimate the association between OGTT-derived indices and lung function measures. An increment of β-cell glucose sensitivity equal to its interquartile range was associated with an increase in ppFEV1 of 7.6 points (95%CI: 0.8; 14.4) as well as with a decrease in LCI of -1.96 units (95%CI: -3.40; -0.51) and in Scond of -0.016 L-1 (95%CI: -0.026; -0.007). The corresponding figures for insulinogenic index were: 8.6 (95%CI: 3.4; 13.9) for ppFEV1 , -2.03 (95%CI: -3.13; -0.94) for LCI, and -0.014 L-1 (95%CI: -0.021; -0.071) for Scond . When adjusting also for 2-h plasma glucose, both β-cell glucose sensitivity and insulinogenic index remained inversely associated with Scond . Deterioration of β-cell function is related to early lung disease in young patients with mild to normal pulmonary function. This relationship is independent from hyperglycemia and mainly involves conductive airways.
Collapse
Affiliation(s)
- Carla Colombo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Simone Gambazza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, U.O.C. Direzione delle Professioni Sanitarie, Milan, Italy
| | - Palmiro Mileto
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Andrea Mari
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Eleonora Grespan
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Erica Nazzari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Maria Chiara Russo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Alberto Battezzati
- Department of Food, Environmental and Nutritional Sciences, International Centre for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Geyer MC, Rayner CK, Horowitz M, Couper JJ. Targeting postprandial glycaemia in children with diabetes: Opportunities and challenges. Diabetes Obes Metab 2018; 20:766-774. [PMID: 29072820 DOI: 10.1111/dom.13141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/02/2017] [Accepted: 10/21/2017] [Indexed: 02/05/2023]
Abstract
Postprandial glycaemia makes a substantial contribution to overall glycaemic control in diabetes, particularly in patients whose preprandial glycaemia is relatively well controlled and glycated haemoglobin (HbA1c) only modestly elevated. Our review addresses the determinants of postprandial glycaemia and how it may be targeted therapeutically in children with diabetes. Postprandial glycaemia is influenced by preprandial glycaemia, macronutrients and their absorption, insulin delivery and sensitivity, the action of the enteroendocrine system, and the rate of gastric emptying. Contemporary continuous glucose monitoring systems reveal patterns of post prandial glycaemia and allow management to be guided more precisely. Delays in blood glucose determination, insulin delivery and its absorption remain challenges in the rapidly evolving closed loop continuous subcutaneous insulin and glucagon delivery systems developed for children with type 1 diabetes. Augmentation of the incretin system through nutritional preloads or incretin mimetics targets postprandial glycaemia by slowing gastric emptying as well as insulinotropic and glucagonostatic effects. These treatments are of particular relevance to children with type 2 diabetes. Following the development of targeted therapies in adults, postprandial blood glucose control will now be increasingly targeted in the treatment of diabetes in children.
Collapse
Affiliation(s)
- Myfanwy C Geyer
- Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Jennifer J Couper
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| |
Collapse
|
11
|
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasian populations. Individuals with CF have seen significant increases in life expectancy in the last 60 years. As a result, previously rare complications are now coming to light. The most common of these is cystic fibrosis-related diabetes (CFRD), which affects 40-50% of CF adults. CFRD significantly impacts the pulmonary function and longevity of CF patients, yet a lack of consensus on the best methods to diagnose and treat CFRD remains. We begin by reviewing our understanding of the pathogenesis of CFRD, as emerging evidence shows the cystic fibrosis transmembrane conductance regulator (CFTR) also has important roles in the release of insulin and glucagon and in the protection of β cells from oxidative stress. We then discuss how current recommended methods of CFRD diagnosis are not appropriate, as continuous glucose monitoring becomes more effective, practical, and cost-effective. Finally, we evaluate emerging treatments which have narrowed the mortality gap within the CF patient group. In the future, pharmacological potentiators and correctors directly targeting CFTR show huge promise for both CFRD and the wider CF patient groups.
Collapse
Affiliation(s)
- Kayani Kayani
- Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Raihan Mohammed
- Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Raihan Mohammed,
| | - Hasan Mohiaddin
- Faculty of Medicine, Imperial College London, London, United Kingdom
| |
Collapse
|
12
|
Oral glucose tolerance test and continuous glucose monitoring to assess diabetes development in cystic fibrosis patients. ENDOCRINOL DIAB NUTR 2018. [DOI: 10.1016/j.endien.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Clemente León M, Bilbao Gassó L, Moreno-Galdó A, Campos Martorrell A, Gartner Tizzano S, Yeste Fernández D, Carrascosa Lezcano A. Oral glucose tolerance test and continuous glucose monitoring to assess diabetes development in cystic fibrosis patients. ACTA ACUST UNITED AC 2017; 65:45-51. [PMID: 29137964 DOI: 10.1016/j.endinu.2017.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patients with cystic fibrosis (CF) undergo a slow and progressive process toward diabetes. Oral glucose tolerance test (OGTT) is recommended to diagnose impaired glucose levels in these patients. Continuous glucose monitoring (CGM) measures glucose profiles under real-life conditions. OBJECTIVE To compare OGTT and CGM results in CF patients. METHODS Paired OGTT and 6-day CGM profiles (146.2±9.1h/patient) were performed in 30 CF patients aged 10-18 years. RESULTS According to OGTT, 14 patients had normal glucose tolerance (NGT), 14 abnormal glucose tolerance (AGT), and two cystic fibrosis-related diabetes (CFRD). In 27 patients (13 NGT, 13 AGT, 1 CFRD), CGM showed glucose values ranging from 140 to 200mg/dL during similar monitoring times (2%-14% with NGT, 1%-16.9% with AGT, and 3% with CFRD). Glucose peak levels ≥200mg/dL were seen in seven patients (3 NGT, 3 AGT, 1 CFRD). According to CGM, two patients had all glucose values under 140mg/dL (1 NGT, 1 AGT). Seventeen patients had glucose levels ranging from 140 to 200mg/dL (10 NGT, 6 AGT, 1 CFRD). Ten patients (3 NGT, 7 AGT) had glucose values ≥200mg/dL for ≤1% of the monitoring time and one (CFRD) for >1% of the monitoring time. CONCLUSIONS OGTT results did not agree with those of the CGM. CGM allows for diagnosis of glucose changes not detected by OGTT. Such changes may contribute to optimize pre-diabetes management in CF patients.
Collapse
Affiliation(s)
- María Clemente León
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain.
| | - Laura Bilbao Gassó
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Spain
| | - Antonio Moreno-Galdó
- Sección de Alergia Pediátrica, Neumología Pediátrica y Fibrosis quística, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Ariadna Campos Martorrell
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Silvia Gartner Tizzano
- Sección de Alergia Pediátrica, Neumología Pediátrica y Fibrosis quística, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Diego Yeste Fernández
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain
| | - Antonio Carrascosa Lezcano
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain
| |
Collapse
|
14
|
Terliesner N, Vogel M, Steighardt A, Gausche R, Henn C, Hentschel J, Kapellen T, Klamt S, Gebhardt J, Kiess W, Prenzel F. Cystic-fibrosis related-diabetes (CFRD) is preceded by and associated with growth failure and deteriorating lung function. J Pediatr Endocrinol Metab 2017; 30:815-821. [PMID: 28245190 DOI: 10.1515/jpem-2017-0005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impaired glucose metabolism and cystic fibrosis (CF)-related diabetes (CFRD) are associated with insufficient weight gain and impaired lung function in children and adolescents with CF. We have asked whether imminent CFRD may be a cause of poor growth in children and adolescents. METHODS A retrospective case control study including 32 patients with CF with or without diabetes was conducted. Sixteen pairs, matched according to age, gender and exocrine pancreatic insufficiency, were analysed. Standard deviation scores (SDS) of height, growth, weight, body mass index (BMI), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and forced expiratory flow at 75% of expired FVC (FEF75) were recorded during a mean observation period of 13 years per patient. RESULTS SDS of height and weight were reduced in CF patients with diabetes compared to those without, not only at the point of diagnosis (both p<0.05) but years before the evidence of diabetes. Afterwards there was a significant decline in height (p<0.001) and weight (p<0.01) SDS in CFRD patients and an increasing difference between the height and weight of CF patients with or without diabetes. In contrast, no significant reduction of BMI-SDS was observed in CFRD patients. All analysed lung function parameters showed a marked decline in CFRD patients starting 1 year prior to the diagnosis of diabetes. CONCLUSIONS Deteriorating growth, reduced weight and impaired lung function are related to the development of CFRD and are obvious several years before the actual diagnosis of diabetes.
Collapse
|
15
|
Molina SA, Moriarty HK, Infield DT, Imhoff BR, Vance RJ, Kim AH, Hansen JM, Hunt WR, Koval M, McCarty NA. Insulin signaling via the PI3-kinase/Akt pathway regulates airway glucose uptake and barrier function in a CFTR-dependent manner. Am J Physiol Lung Cell Mol Physiol 2017; 312:L688-L702. [PMID: 28213469 PMCID: PMC5451595 DOI: 10.1152/ajplung.00364.2016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 12/13/2022] Open
Abstract
Cystic fibrosis-related diabetes is the most common comorbidity associated with cystic fibrosis (CF) and correlates with increased rates of lung function decline. Because glucose is a nutrient present in the airways of patients with bacterial airway infections and because insulin controls glucose metabolism, the effect of insulin on CF airway epithelia was investigated to determine the role of insulin receptors and glucose transport in regulating glucose availability in the airway. The response to insulin by human airway epithelial cells was characterized by quantitative PCR, immunoblot, immunofluorescence, and glucose uptake assays. Phosphatidylinositol 3-kinase/protein kinase B (Akt) signaling and cystic fibrosis transmembrane conductance regulator (CFTR) activity were analyzed by pharmacological and immunoblot assays. We found that normal human primary airway epithelial cells expressed glucose transporter 4 and that application of insulin stimulated cytochalasin B-inhibitable glucose uptake, consistent with a requirement for glucose transporter translocation. Application of insulin to normal primary human airway epithelial cells promoted airway barrier function as demonstrated by increased transepithelial electrical resistance and decreased paracellular flux of small molecules. This provides the first demonstration that airway cells express insulin-regulated glucose transporters that act in concert with tight junctions to form an airway glucose barrier. However, insulin failed to increase glucose uptake or decrease paracellular flux of small molecules in human airway epithelia expressing F508del-CFTR. Insulin stimulation of Akt1 and Akt2 signaling in CF airway cells was diminished compared with that observed in airway cells expressing wild-type CFTR. These results indicate that the airway glucose barrier is regulated by insulin and is dysfunctional in CF.
Collapse
Affiliation(s)
- Samuel A Molina
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia;
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Hannah K Moriarty
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel T Infield
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonology, Allergy & Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and
| | - Barry R Imhoff
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonology, Allergy & Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and
| | - Rachel J Vance
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Agnes H Kim
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jason M Hansen
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - William R Hunt
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Koval
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia
| | - Nael A McCarty
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonology, Allergy & Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and
| |
Collapse
|
16
|
Screening for Cystic Fibrosis-Related Diabetes: Matching Pathophysiology and Addressing Current Challenges. Can J Diabetes 2016; 40:466-470. [DOI: 10.1016/j.jcjd.2016.08.221] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 12/17/2022]
|
17
|
Prentice B, Hameed S, Verge CF, Ooi CY, Jaffe A, Widger J. Diagnosing cystic fibrosis-related diabetes: current methods and challenges. Expert Rev Respir Med 2016; 10:799-811. [DOI: 10.1080/17476348.2016.1190646] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Bernadette Prentice
- Department of Respiratory Medicine, Sydney Children’s Hospital, Randwick, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
| | - Shihab Hameed
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
- Department of Endocrinology, Sydney Children’s Hospital, Randwick, Australia
| | - Charles F. Verge
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
- Department of Endocrinology, Sydney Children’s Hospital, Randwick, Australia
| | - Chee Y. Ooi
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
- Department of Gastroenterology, Sydney Children’s Hospital, Randwick, Australia
| | - Adam Jaffe
- Department of Respiratory Medicine, Sydney Children’s Hospital, Randwick, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
| | - John Widger
- Department of Respiratory Medicine, Sydney Children’s Hospital, Randwick, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
| |
Collapse
|
18
|
Olszowiec-Chlebna M, Koniarek-Maniecka A, Stelmach W, Smejda K, Jerzyńska J, Majak P, Białas M, Stelmach I. Predictors of deterioration of lung function in Polish children with cystic fibrosis. Arch Med Sci 2016; 12:402-7. [PMID: 27186187 PMCID: PMC4848371 DOI: 10.5114/aoms.2016.59268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/21/2014] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Severity of lung disease varies in patients with the same CFTR genotype. It suggests that other factors affect the severity of cystic fibrosis (CF). The aim of the study was to identify risk factors that determine lung function decline in Polish cystic fibrosis children. MATERIAL AND METHODS The follow-up time was no less than 5 years of respiratory status observation based on the forced expiratory volume in 1 s value (FEV1). The socio-economic data, perinatal interview, presence of meconium ileus (MI), time of CF diagnosis, initiation of tobramycin inhalation solution (TIS), pancreatic function, sensitization to Aspergillus fumigatus, presence of impaired glucose tolerance (IGT) or diabetes mellitus, chronic bacterial colonization and number of exacerbations and hospitalizations were assessed. RESULTS The mean age of 61 included children was 13.3 ±7.6 years. Delta F508 homozygosity was detected in 45.9%, 44.3% were delta F508 heterozygous, and 9.8% had other genotypes. FEV1 decline was observed among 20% of patients; the rest of the patients presented stable values of FEV1 during at least 5 years of observation. The most significant predictors related to the decline of FEV1 were presentation of MI (p = 0.0344), IGT (p = 0.0227), number of exacerbations (p = 0.0288), and early Pseudomonas aeruginosa (PA) chronic colonization (p = 0.0165) followed by late TIS initiation after the first detection of PA (p=0.0071). Neither time of diagnosis nor type of CFTR mutation was statistically significant as a predictor of lung deterioration. CONCLUSIONS The presence of MI, IGT, chronic PA colonization, and number of exacerbations are risk factors for lung function deterioration.
Collapse
Affiliation(s)
| | - Agnieszka Koniarek-Maniecka
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Włodzimierz Stelmach
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Smejda
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Paweł Majak
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Monika Białas
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| | - Iwona Stelmach
- Department of Pediatrics and Allergy, Nicolaus Copernicus Hospital, Medical University of Lodz, Lodz, Poland
| |
Collapse
|