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Sherwood JS, Castellanos LE, O’Connor MY, Balliro CA, Hillard MA, Gaston SG, Bartholomew R, Greaux E, Sabean A, Zheng H, Marchetti P, Uluer A, Sawicki GS, Neuringer I, El-Khatib FH, Damiano ER, Russell SJ, Putman MS. Randomized Trial of the Insulin-Only iLet Bionic Pancreas for the Treatment of Cystic Fibrosis- Related Diabetes. Diabetes Care 2024; 47:101-108. [PMID: 37874987 PMCID: PMC10733649 DOI: 10.2337/dc23-1411] [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: 07/30/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Cystic fibrosis-related diabetes (CFRD) affects up to 50% of adults with cystic fibrosis and adds significant morbidity and treatment burden. We evaluated the safety and efficacy of automated insulin delivery with the iLet bionic pancreas (BP) in adults with CFRD in a single-center, open-label, random-order, crossover trial. RESEARCH DESIGN AND METHODS Twenty participants with CFRD were assigned in random order to 14 days each on the BP or their usual care (UC). No restrictions were placed on diet or activity. The primary outcome was the percent time sensor-measured glucose was in target range 70-180 mg/dL (time in range [TIR]) on days 3-14 of each arm, and key secondary outcomes included mean continuous glucose monitoring (CGM) glucose and the percent time sensor-measured glucose was in hypoglycemic range <54 mg/dL. RESULTS TIR was significantly higher in the BP arm than the UC arm (75 ± 11% vs. 62 ± 22%, P = 0.001). Mean CGM glucose was lower in the BP arm than in the UC arm (150 ± 19 vs. 171 ± 45 mg/dL, P = 0.007). There was no significant difference in percent time with sensor-measured glucose <54 mg/dL (0.27% vs. 0.36%, P = 1.0), although self-reported symptomatic hypoglycemia episodes were higher during the BP arm than the UC arm (0.7 vs. 0.4 median episodes per day, P = 0.01). No episodes of diabetic ketoacidosis or severe hypoglycemia occurred in either arm. CONCLUSIONS Adults with CFRD had improved glucose control without an increase in CGM-measured hypoglycemia with the BP compared with their UC, suggesting that this may be an important therapeutic option for this patient population.
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Affiliation(s)
| | | | | | - Courtney A. Balliro
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
- Beta Bionics Inc., Concord, MA
| | - Mallory A. Hillard
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
- Beta Bionics Inc., Concord, MA
| | | | | | - Evelyn Greaux
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Amy Sabean
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Hui Zheng
- Biostatics Center, Massachusetts General Hospital, Boston, MA
| | - Peter Marchetti
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA
| | - Ahmet Uluer
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA
- Division of Pulmonology, Brigham and Women’s Hospital, Boston, MA
| | | | - Isabel Neuringer
- Division of Pulmonology and Critical Care, Massachusetts General Hospital, Boston, MA
| | | | - Edward R. Damiano
- Beta Bionics Inc., Concord, MA
- Department of Biomedical Engineering, Boston University, Boston, MA
| | - Steven J. Russell
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
- Beta Bionics Inc., Concord, MA
| | - Melissa S. Putman
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
- Department of Endocrinology, Boston Children’s Hospital, Boston, MA
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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.
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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.
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3
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Kutney K, Kaminski BA, Casey T, O'Riordan M, Gubitosi-Klug R. Reproducibility of in-home CFRD screening using continuous glucose monitoring and mixed meal tolerance test. J Clin Transl Endocrinol 2023; 33:100323. [PMID: 37705602 PMCID: PMC10495624 DOI: 10.1016/j.jcte.2023.100323] [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: 06/02/2023] [Revised: 07/23/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023] Open
Abstract
Background Cystic fibrosis related diabetes (CFRD) is associated with insulin-remediable pulmonary decline, so early detection is critical. Continuous glucose monitors (CGM) have shown promise in screening but are not recommended by clinical practice guidelines. Little is known about the reproducibility of CGM results for a given patient. Methods Twenty non-insulin treated adults and adolescents with CF placed an in-home CGM and wore it for two 14-day periods. Participants underwent a mixed meal tolerance test (MMTT) on day 5 of each 14-day period. Glycemic data from CGM 1 and CGM 2 were compared regarding published thresholds to define abnormality: percent time >140 mg/dL of ≥4.5%, percent time >140 mg/dL of >17.5%, and percent time >180 mg/dL of >3.4%. Results of the repeat MMTT were compared for peak glucose and 2-hour glucose thresholds: >140 mg/dL, >180 mg/dL, and >200 mg/dL. Results For percent time >140 mg/dL of ≥ 4.5%, five of 20 subjects had conflicting results between CGM 1 and CGM 2. For percent time >140 mg/dL of >17.5% and >180 mg/dL of >3.4%, only one of 20 subjects had conflicting results between CGM 1 and CGM 2. On the MMTT, few participants had a 2-hour glucose >140 mg/dL. Peak glucose >140 mg/dL, 180 mg/dL, and 200 mg/dL were more common, with 10-37% of participants demonstrating disagreement between CGM 1 and CGM 2. Conclusions Repeated in-home CGM acquisitions show reasonable reproducibility regarding the more stringent thresholds for time >140 mg/dL and >180 mg/dL. More data is needed to determine thresholds for abnormal mixed meal tolerance tests in CFRD screening.
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Affiliation(s)
- Katherine Kutney
- Case Western Reserve University, Cleveland OH, United States
- University Hospitals Rainbow Babies and Children’s Hospital, Cleveland OH, United States
| | - Beth A. Kaminski
- Case Western Reserve University, Cleveland OH, United States
- University Hospitals Rainbow Babies and Children’s Hospital, Cleveland OH, United States
| | - Terri Casey
- Case Western Reserve University, Cleveland OH, United States
- University Hospitals Rainbow Babies and Children’s Hospital, Cleveland OH, United States
| | - MaryAnn O'Riordan
- Case Western Reserve University, Cleveland OH, United States
- University Hospitals Rainbow Babies and Children’s Hospital, Cleveland OH, United States
| | - Rose Gubitosi-Klug
- Case Western Reserve University, Cleveland OH, United States
- University Hospitals Rainbow Babies and Children’s Hospital, Cleveland OH, United States
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4
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Merjaneh L, Sidhaye AR, Vu PT, Heltshe SL, Goss CH, Flume PA, Kelly A, Rosenfeld M. Role of hyperglycemia in cystic fibrosis pulmonary exacerbations. J Cyst Fibros 2023; 22:868-874. [PMID: 37394317 PMCID: PMC10756929 DOI: 10.1016/j.jcf.2023.06.011] [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: 08/22/2022] [Revised: 06/09/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Hyperglycemia could affect treatment response during cystic fibrosis (CF) exacerbations. We aimed to evaluate the prevalence and associations of hyperglycemia with exacerbation outcomes. We also evaluated feasibility of continuous glucose monitoring (CGM) during exacerbations. METHODS The STOP2 study assessed efficacy and safety of different durations of intravenous antibiotics for CF exacerbations. We conducted a secondary data analysis of random glucose levels measured as part of clinical care during exacerbations. A small subset of participants also underwent CGM per research protocol. The associations between hyperglycemia, defined as random glucose ≥140 mg/dL, and changes in weight and lung function with exacerbation treatment were evaluated with linear regression after adjustment for confounding variables. RESULTS Glucose levels were available for 182 STOP2 participants of mean (SD) age 31.6 (10.8) years, baseline percent predicted (pp) FEV1 53.6 (22.5); 37% had CF related diabetes and 27% were on insulin. Hyperglycemia was detected in 44% of participants. Adjusted mean difference (95% CI) was 1.34% (-1.39, 4.08) (p = 0.336) for change in ppFEV1 and 0.33 kg (-0.11, 0.78) (p = 0.145) for change in weight between hyperglycemic and non-hyperglycemic groups. Ten participants not on antidiabetic agents in the 4 weeks prior to enrollment underwent CGM; mean (SD) time spent >140 mg/dL was 24.6% (12.5) with 9/10 participants spending >4.5% time >140 mg/dL. CONCLUSIONS Hyperglycemia identified with random glucose is prevalent during CF exacerbations but not associated with changes in lung function or weight with exacerbation treatment. CGM is feasible and may provide a useful tool for hyperglycemia monitoring during exacerbations.
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Affiliation(s)
- Lina Merjaneh
- Division of Endocrinology and Diabetes, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98145, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Aniket R Sidhaye
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD 21287, USA
| | - Phuong T Vu
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA
| | - Sonya L Heltshe
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA
| | - Christopher H Goss
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Patrick A Flume
- Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Andrea Kelly
- Department of Pediatrics, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98145, USA
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5
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Wolinsky T, Simon B. Rapid-Acting Insulin Used to Treat a Case of Early Cystic Fibrosis-Related Diabetes Complicated by Post Prandial Hypoglycemia. AACE Clin Case Rep 2023; 9:170-173. [PMID: 37736319 PMCID: PMC10509377 DOI: 10.1016/j.aace.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/11/2023] [Accepted: 07/11/2023] [Indexed: 09/23/2023] Open
Abstract
Background/Objective Cystic fibrosis-related diabetes (CFRD) is one of the most common nonrespiratory complications of cystic fibrosis (CF). There is a lack of clinical research to provide guidance on optimal treatment regimens for various subtypes of CFRD. Case Report This case describes an 18-year-old woman, diagnosed with CF in infancy, who presented to our clinic for evaluation of possible CFRD and episodes of hypoglycemia. Subsequent testing revealed normal fasting glucose with elevated blood glucose levels on oral glucose tolerance test, consistent with the diagnosis of CFRD without fasting hyperglycemia. She was found to have large glycemic excursions after carbohydrate-containing meals, followed by delayed postprandial hypoglycemia. Discussion We initiated low-dose mealtime rapid-acting analog insulin and saw both a decrease in her postprandial hyperglycemia as well as resolution of her hypoglycemic episodes. Conclusion This case highlights the spectrum of pancreatic dysfunction and insulin dysregulation in CFRD as well as the benefit of prandial insulin alone as a treatment option.
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Affiliation(s)
- Tamar Wolinsky
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Barbara Simon
- Division of Endocrinology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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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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7
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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.
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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.
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Granger E, Keogh RH, Frost F. The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data. ERJ Open Res 2022; 8:00170-2022. [PMID: 36382232 PMCID: PMC9638829 DOI: 10.1183/23120541.00170-2022] [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: 04/05/2022] [Accepted: 07/14/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis and is associated with deleterious clinical outcomes. Insulin is recommended as a treatment by international guidelines. However, there are scarce clinical trial data to support the use of insulin, and little is known about the long-term outcomes of treatment. The aim of this study was to compare the long-term impacts of insulin use versus non-use in CFRD. Methods We used data from the national UK Cystic Fibrosis Registry and adopted a target trial framework. Eligible individuals included those 12 years and older with a new diagnosis of CFRD. Outcomes were change in % predicted forced expiratory volume in 1 s (FEV1 %) and body mass index z-scores (BMI) over a 5-year follow-up period. Treatment strategies were to receive insulin or not for the duration of follow-up. Treatment effect estimates were obtained using two methods to control for confounding: inverse-probability-of-treatment weighted estimation of marginal structural models and the G-formula. Results We identified 1613 individuals diagnosed with CFRD between 2008 and 2016 and included 1196 and 1192 in the FEV1 % and BMI outcome analyses respectively. We found no evidence of an effect of insulin on FEV1 % over the 5-year study period. Similarly, we found no overall effect of insulin on BMI; however, there was some evidence for a positive treatment effect in patients with lower baseline BMI. Conclusion Using well-established national registry data, we found no evidence of long-term treatment effects for insulin on FEV1 % or BMI in people with incident CFRD. This target trial using registry data to estimate the effects of insulin use on clinical outcomes in incident cystic fibrosis-related diabetes found no evidence of a long-term benefit (up to 5 years) of insulin use on lung function or BMIhttps://bit.ly/3B8azKz
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Kasim N, Khare S, Sandouk Z, Chan C. Impaired glucose tolerance and indeterminate glycemia in cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100275. [PMID: 34868882 PMCID: PMC8626567 DOI: 10.1016/j.jcte.2021.100275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Oral glucose tolerance testing is used for screening, diagnosis, and risk stratification of cystic fibrosis related diabetes. Abnormal glucose tolerance in cystic fibrosis has prognostic utility with regards to progression towards overt diabetes, pulmonary function, weight loss, and mortality. Further research is needed to delineate the significance of impaired glucose tolerance and indeterminate glycemia within the CF population. Lower thresholds for indeterminate glycemia may be needed within the cystic fibrosis population.
Oral glucose tolerance testing (OGTT) is the primary method to screen for and diagnose cystic fibrosis-related diabetes (CFRD). Diagnostic thresholds as currently defined are based on microvascular complications seen in type 2 diabetes. Abnormal glucose tolerance (AGT) refers to OGTT glucose elevations outside the normal range and encompasses both impaired and indeterminate glucose tolerance. Current guidelines define impaired glucose tolerance (IGT) as a 2-hour glucose of 140–199 mg/dL (7.8–11 mmol/L) and indeterminate glucose tolerance (INDET) as any mid-OGTT glucose ≥ 200 mg/dL (11.1 mmol/L) with a normal fasting and 2 h glucose. There is growing evidence that AGT also has associations with CF-centered outcomes including pulmonary decline, hospitalizations, and weight loss. Here we aim to review the historical emergence of glucose tolerance testing, review relevance to risk stratification for CFRD, discuss alternate cutoffs for identifying AGT earlier, and highlight the need for larger, future studies to inform our understanding of the implications of IGT and INDET on CF health.
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Affiliation(s)
- Nader Kasim
- Division of Pediatric Endocrinology and Diabetes, Helen Devos Children’s Hospital, Grand Rapids, MI, USA
- Corresponding author at: 35 Michigan St. NE, Suite 1800, Grand Rapids, MI 49546, USA.
| | - Swapnil Khare
- Department of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN, USA
| | - Zahre Sandouk
- Metabolism, Endocrinology and Nutrition Division, Internal Medicine Department, University of Michigan, Ann Arbor, MI, USA
| | - Christine Chan
- Department of Pediatrics, Division of Endocrinology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Toner A, McCloy A, Dyce P, Nazareth D, Frost F. Continuous glucose monitoring systems for monitoring cystic fibrosis-related diabetes. Cochrane Database Syst Rev 2021; 11:CD013755. [PMID: 34844283 PMCID: PMC8629645 DOI: 10.1002/14651858.cd013755.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is one of the most common life-shortening autosomal-recessive genetic conditions with around 100,000 people affected globally. CF mainly affects the respiratory system, but cystic fibrosis-related diabetes (CFRD) is a common extrapulmonary co-morbidity and causes excess morbidity and mortality in this population. Continuous glucose monitoring systems (CGMS) are a relatively new technology and, as yet, the impact of these on the monitoring and subsequent management of CFRD remains undetermined. OBJECTIVES To establish the impact of insulin therapy guided by continuous glucose monitoring compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 23 September 2021. We also searched the reference lists of relevant articles and reviews and online trials registries. Date of last search: 23 September 2021. SELECTION CRITERIA Randomised controlled studies comparing insulin regimens led by data from CGMS (including real-time or retrospective data, or both) with insulin regimens guided by abnormal blood glucose measurements collected through other means of glycaemic data collection in people with CFRD. Studies with a cross-over design, even with a washout period between intervention arms, are not eligible for inclusion due to the potential long-term impact of each of the interventions and the potential to compromise the outcomes of the second intervention. DATA COLLECTION AND ANALYSIS No studies were included in the review, meaning that no data were available to be collected for analysis. MAIN RESULTS Review authors screened 14 studies at the full-text stage against the review's inclusion criteria. Consequently, seven were excluded due to the study type being ineligible (not randomised), two studies were excluded due to their cross-over design, and two studies was excluded since the intervention used was not eligible and one was a literature review. One study in participants hospitalised for a pulmonary exacerbation is ongoing. Investigators are comparing insulin dosing via insulin pump with blood sugar monitoring by a CGMS to conventional diabetes management with daily insulin injections (or on an insulin pump if already on an insulin pump in the outpatient setting) and capillary blood glucose monitoring. The participants in the control arm will wear a blinded continuous glucose monitoring system for outcome assessment. In addition to this, one further study is still awaiting classification, and will be screened to determine whether it is eligible for inclusion, or is to be excluded, in an update of this review. AUTHORS' CONCLUSIONS No studies were included in the review, indicating that there is currently insufficient evidence to determine the impact of insulin therapy guided by CGMS compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD, nor on potential adverse effects of continuous glucose monitoring in this context. Randomised controlled studies are needed to generate evidence on the efficacy and safety of continuous glucose monitoring in people with CFRD. There is one relevant ongoing study that may be eligible for inclusion in a future update of this Cochrane Review, and whose results may help answer the review question.
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Affiliation(s)
- Aileen Toner
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Anna McCloy
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Paula Dyce
- Cystic Fibrosis/Respiratory Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Dilip Nazareth
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Freddy Frost
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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11
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Marks BE, Kilberg MJ, Aliaj E, Fredkin K, Hudson J, Riva D, Román C, Kelly A, Putman MS. Perceptions of Diabetes Technology Use in Cystic Fibrosis-Related Diabetes Management. Diabetes Technol Ther 2021; 23:753-759. [PMID: 34185606 DOI: 10.1089/dia.2021.0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Diabetes technologies are associated with improvements in glycemic control and health-related quality of life among people with type 1 diabetes (T1D). Use and perceptions of continuous glucose monitors (CGM) and insulin pumps within the cystic fibrosis (CF) community have not been well studied. Methods: A 30-item online survey addressing cystic fibrosis-related diabetes (CFRD) diagnosis, CGM and insulin pump use, and perceptions of diabetes technologies was sent to a CF community group, including people with CF (pwCF) and parents of children with CF (cwCF). Results: The response rate was 11% (n = 120; 83 pwCF, 35 cwCF). Sixty-one percent of pwCF and 34% of cwCF reported a diagnosis of CFRD. CGM use was reported by 75% (n = 47) of respondents with CFRD but was discontinued by 19% (n = 9), most commonly due to cost and increased worry about glycemia. Insulin pump therapy was reported by 29% (n = 18 of 62) of respondents with CFRD and was discontinued by 28% (n = 5), most commonly due to pain or skin irritation. Overall, 91% agreed or strongly agreed that CGM facilitated CFRD management. Eighty-one percent agreed with at least five of seven positive statements about CGM as compared with 22% for insulin pumps. Potential embarrassment over device wear, concerns about cost, and pain were commonly held negative perceptions of both technologies. Conclusions: As compared with T1D and despite perceived benefits, rates of sustained diabetes technology use are low in the CFRD community. Better insurance coverage to mitigate cost, better patient education, and confirmation that these technologies improve health and patient-reported outcomes may increase uptake.
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Affiliation(s)
- Brynn E Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Marissa J Kilberg
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Enid Aliaj
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | | | | | - Dara Riva
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | | | - Andrea Kelly
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa S Putman
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Departments of Pediatrics and Medicine, Harvard Medical School, Boston, Massachusetts, USA
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12
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Potter KJ, Reynaud Q, Boudreau V, Racine F, Tremblay F, Lavoie A, Carricart M, Mailhot G, Durieu I, Senior PA, Rabasa-Lhoret R. Combined Indeterminate and Impaired Glucose Tolerance Is a Novel Group at High Risk of Cystic Fibrosis-Related Diabetes. J Clin Endocrinol Metab 2021; 106:e3901-e3910. [PMID: 34132785 DOI: 10.1210/clinem/dgab384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Indeterminate glycemia (INDET) and impaired glucose tolerance (IGT) are independently associated with cystic fibrosis-related diabetes (CFRD) risk. We determined whether patients meeting both criteria have increased risk of diabetes in 2 separate adult cohorts. METHODS The Montreal Cystic Fibrosis Cohort (MCFC; n = 293 baseline and 198 for prospective analysis excluding subjects identified with incident CFRD at baseline) and the Lyon cystic fibrosis cohort [Determination of the Predictive Factors in the Reversibility or the Aggravation in the Disorders of the Glucose Metabolism in Cystic Fibrosis Patients (DIAMUCO); n = 144/105] are prospective observational cohorts. RESULTS In the MCFC and DIAMUCO cohorts, mean age was 25.5 ± 7.7 and 25.0 ± 8.6 years; body mass index, 21.7 ± 3.0 and 20.2 ± 2.2 kg/m2; percentage of forced expiratory volume expired in 1 sec, 73.2 ± 22.1 and 62.5 ± 21.9; and follow-up, 6.9 ± 3.8 and 2.4 ± 1.2 years, respectively. In the MCFC cohort, the IGT only and combined INDET and IGT (INDET + IGT) groups had greater risk of CFRD (P = 0.0109). In the DIAMUCO cohort, there was lower diabetes-free survival in the INDET + IGT group (P = 0.0105). In both cohorts, CFRD risk ranged from 17% in normal glucose tolerance patients up to 42% to 56% in patients with INDET + IGT. CONCLUSION Patients who meet combined criteria have a higher risk of developing diabetes probably justifying closer follow-up.
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Affiliation(s)
| | - Quitterie Reynaud
- Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France
- Department of internal medicine, Université de Lyon, Lyon, France
| | - Valérie Boudreau
- Montreal Clinical Research Institute, Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Florence Racine
- Montreal Clinical Research Institute, Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - François Tremblay
- 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
| | - Annick Lavoie
- 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
| | - Maite Carricart
- 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
| | - Geneviève Mailhot
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Isabelle Durieu
- Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France
- Department of internal medicine, Université de Lyon, Lyon, France
| | - Peter A Senior
- Department of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Department of Endocrinology, Faculty of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), 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
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13
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Granados A, Beach EA, Christiansen AJ, Patterson BW, Wallendorf M, Arbeláez AM. The association between body composition, leptin levels and glucose dysregulation in youth with cystic fibrosis. J Cyst Fibros 2021; 20:796-802. [PMID: 34183284 PMCID: PMC8552309 DOI: 10.1016/j.jcf.2021.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Optimization of nutritional status is recommended in patients with cystic fibrosis (CF) given the association between lower body mass index (BMI) and poor clinical outcomes. However, higher BMI and body fat correlate with glucose impairment and higher leptin levels in the general population. Differences in body composition and leptin levels between the categories of glucose tolerance were assessed in youth with CF and healthy controls. METHODS In a cross-sectional study, 59 adolescents and young adults with CF and 15 healthy controls matched by age and gender, underwent body composition analysis using dual energy X-ray absorptiometry (DXA) and a 2-hour oral glucose tolerance test (OGTT). Measures of insulin sensitivity, β-cell insulin secretion and fasting leptin levels were obtained. RESULTS Of the participants with CF, 62% were classified as abnormal glucose tolerant and 22% with cystic fibrosis related diabetes (CFRD). Patients with CFRD had a lower fat mass index (FMI) z-score, wt z-score and leptin levels compared to the control group (-1.86 vs. - 0.59, p=0.01; -1.86 vs 0.44, p=<0.001 and 7.9 vs vs. 27.7 µg/L, p=0.01). Leptin correlated positively with FMI z-score, BMI, weight z-score and indices of insulin secretion. FMI z-score correlated positively with higher insulin resistance (HOMA-IR), and lower insulin sensitivity (Matsuda index) (r=0.31; p =0.01 and r=-0.29; p=0.02, respectively) in the CF group. CONCLUSIONS This study shows that despite new therapeutic strategies, youth with CF have lower body fat, weight z-score and leptin levels, particularly in subjects with early onset CFRD.
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Affiliation(s)
- Andrea Granados
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO. USA.
| | - Elizabeth A Beach
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO. USA
| | - Andrew J Christiansen
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO. USA
| | - Bruce W Patterson
- University of Nebraska Medical Center, Department of Surgery, Omaha, NE. USA
| | - Michael Wallendorf
- Washington University School of Medicine, Department of Medicine, St. Louis, MO. USA; Washington University School of Medicine, Division of Biostatistics, St. Louis, MO. USA
| | - Ana María Arbeláez
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO. USA
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14
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Potter KJ, Boudreau V, Shohoudi A, Mailhot M, Tremblay F, Lavoie A, Carricart M, Senior PA, Rabasa-Lhoret R. Influence of pre-diabetic and pancreatic exocrine states on pulmonary and nutritional status in adults with Cystic Fibrosis. J Cyst Fibros 2021; 20:803-809. [PMID: 33353861 DOI: 10.1016/j.jcf.2020.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In 1992, a landmark study demonstrated clinical deterioration in respiratory function and nutritional status prior to the onset of cystic fibrosis-related diabetes (CFRD). We re-evaluated this outcome. METHODS The Montreal Cystic Fibrosis Cohort is a prospective CFRD screening study. We performed a 6-year retrospective analysis of nutritional parameters and FEV1 (%) in subjects who developed incident CFRD and in controls who maintained normoglycemia (NG). In the former group, data was collected over 6 years prior to diabetes onset. RESULTS Subjects (n = 86) had a mean age of 31.7 ± 8.1 years, BMI of 23.0 ± 4.0 kg/m2, and FEV1% of 70.1 ± 24.2%. Eighty-one percent had pancreatic insufficiency (PI). Patients were grouped as follows: NG+PS (pancreatic sufficient) (n = 16), NG+PI (pancreatic insufficient) (n = 21), CFRD+PS (n = 3) and CFRD+PI (n = 46). At their most recent screen NG+PS subjects had significantly greater BMI, as compared to NG+PI and CFRD+PI groups (26.2 ± 3.6 kg/m2 vs 22.6 ± 4.2 kg/m2 vs 22.1 ± 3.5 kg/m2, p = 0.0016). FEV1 was significantly greater in the NG+PS group (91.5 ± 16.8% vs 67.8 ± 25.3% vs 63.5 ± 22.2%, p = 0.0002). The rates of change in weight, BMI, fat mass (%), and FEV1 prior to the most recent visit (NG+PS, NG+PI groups) or to the diagnosis of de novo CFRD were similar between groups. CONCLUSION In a contemporary context, CFRD onset is not preceded by deterioration in BMI, fat mass, or pulmonary function. Low BMI and FEV1 are more closely associated with PI than a pre-diabetic state.
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Affiliation(s)
- Kathryn J Potter
- 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
| | - Azadeh Shohoudi
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Marjolaine Mailhot
- Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - François Tremblay
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada; Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Annick Lavoie
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Maité Carricart
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Peter A Senior
- Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal, 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.
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15
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Toner A, McCloy A, Dyce P, Nazareth D, Frost F. Continuous glucose monitoring systems for monitoring cystic fibrosis-related diabetes. Hippokratia 2020. [DOI: 10.1002/14651858.cd013755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Aileen Toner
- Institute of Child Health; University of Liverpool; Liverpool UK
| | - Anna McCloy
- School of Medicine; University of Liverpool; Liverpool UK
| | - Paula Dyce
- Cystic Fibrosis/Respiratory Department; Liverpool Heart and Chest Hospital NHS Foundation Trust; Liverpool UK
| | - Dilip Nazareth
- Adult CF Centre; Liverpool Heart & Chest Hospital; Liverpool UK
| | - Freddy Frost
- Adult CF Centre; Liverpool Heart & Chest Hospital; Liverpool UK
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16
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Tommerdahl KL, Brinton JT, Vigers T, Cree-Green M, Zeitler PS, Nadeau KJ, Chan CL. Delayed glucose peak and elevated 1-hour glucose on the oral glucose tolerance test identify youth with cystic fibrosis with lower oral disposition index. J Cyst Fibros 2020; 20:339-345. [PMID: 32928701 DOI: 10.1016/j.jcf.2020.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/24/2020] [Accepted: 08/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alternate methods for characterizing oral glucose tolerance tests (OGTT) have emerged as superior to the 2-hour glucose in identifying individuals at risk for type 2 diabetes. The significance of these methods in cystic fibrosis (CF) is unclear. We compared 3 OGTT classifications in youth with CF: 1. curve shape (biphasic vs. monophasic), 2. time to glucose peak (≤30minutes vs. >30minutes), 3. 1-hour glucose (1hG) <155 mg/dL vs. ≥155 mg/dL to traditional OGTT criteria to determine which best identifies lower oral disposition index (oDI), pulmonary function, and body mass index (BMI). METHODS Youth 10-18 years with CF, not on insulin, underwent 2-hour OGTT. Glucoses were classified by traditional criteria and 3 alternate methods as normal (biphasic curve, glucose peak ≤30minutes, and/or 1hG <155 mg/dL) or abnormal (monophasic curve, glucose peak >30minutes, and/or 1hG ≥155 mg/dL). oDI was calculated [1/fasting insulin*(ΔInsulin0-30 min/ΔGlucose0-30 min)]. Mean oDI, BMI, forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) were compared by OGTT classification. RESULTS Fifty-two youth with CF participated (mean±SD age 13±4years; 37% male; BMI z-score 0.0±0.8; FEV1 88±16.3%; FVC 97±14.8%). Late time to peak glucose and 1hG ≥155 mg/dL identified individuals with lower oDI (p=0.01); traditional OGTT criteria for prediabetes did not. No OGTT classification identified individuals with worse BMI nor pulmonary function. oDI was not associated with BMI, FEV1, or FVC. CONCLUSIONS Alternate OGTT measures including time to peak glucose and 1hG better identify oDI abnormalities than traditional criteria. Further studies are required to determine whether these alternate methods identify individuals with CF at risk for future clinical decline.
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Affiliation(s)
- Kalie L Tommerdahl
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA; Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - John T Brinton
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Tim Vigers
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Melanie Cree-Green
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Zeitler
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christine L Chan
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Bidirectional relationship between diabetes and pulmonary function: a systematic review and meta-analysis. DIABETES & METABOLISM 2020; 47:101186. [PMID: 32889114 DOI: 10.1016/j.diabet.2020.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/25/2020] [Accepted: 08/01/2020] [Indexed: 01/29/2023]
Abstract
AIM Evidence of the lungs being a target organ of diabetes-related pathophysiology is increasing, and decreased pulmonary function increases the risk of diabetes after adjusting for demographic and metabolic factors. This systematic review and meta-analysis evaluates the bidirectional relationship between diabetes and pulmonary function. METHODS MEDLINE, Embase, The Cochrane Library and Web of Science databases were searched, and all studies describing this bidirectional relationship were identified. Two reviewers independently extracted study characteristics and assessed the risk of bias. RESULTS A total of 93 studies were included in the meta-analysis. The pooled weighted mean difference (WMD) between diabetes patients and non-diabetic participants for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were -5.65% and -5.91%, respectively, of predicted values. Diabetes-related microvascular complications and poor glycaemic control were associated with poorer pulmonary function in those with diabetes. In addition, diabetes was associated with a restrictive spirometry pattern (RSP) in both cross-sectional studies [odds ratio (OR): 2.88, 95% confidence interval (CI): 2.18-3.81, I2 = 0.0%] and prospective cohort studies [hazard ratio (HR): 1.57, 95% CI: 1.04-2.36]. In five longitudinal studies, the conclusions were inconsistent as to whether or not diabetes accelerates pulmonary function decline. However, every 10% decrease in baseline predicted FVC value was associated with a 13% higher risk of incident diabetes (HR: 1.13, 95% CI: 1.09-1.17, I2 = 0.0%). CONCLUSION There is a bidirectional relationship between diabetes and pulmonary function. However, further investigations into whether dynamic changes in glycaemic levels before and shortly after diabetes onset mediate the deleterious effects on pulmonary function, or vice versa, are now required.
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18
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F F, Mj W, D N. Cystic Fibrosis Related Diabetes - An Update. QJM 2020; 115:hcaa256. [PMID: 32821951 DOI: 10.1093/qjmed/hcaa256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/18/2020] [Accepted: 08/06/2020] [Indexed: 11/12/2022] Open
Abstract
Cystic fibrosis (CF) is the most common life-threatening inherited condition in the Caucasian population, where mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene result in a multifactorial syndrome, with pulmonary disease representing the largest contributor to morbidity and mortality. Life expectancy has improved and the recent development of disease-modifying CFTR modulator therapies is likely to further improve survival. However, increasing life expectancy brings new challenges related to the complications of a chronic disease including an increasing prevalence of cystic fibrosis related diabetes (CFRD), itself associated with increased morbidity and early mortality. This review provides an update as regards the underlying mechanisms, investigation and management of CFRD.
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Affiliation(s)
- Frost F
- Adult CF Centre, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Walshaw Mj
- Adult CF Centre, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Nazareth D
- Adult CF Centre, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
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20
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Sheikh S, Localio AR, Kelly A, Rubenstein RC. Abnormal glucose tolerance and the 50-gram glucose challenge test in Cystic fibrosis. J Cyst Fibros 2020; 19:696-699. [PMID: 31974039 DOI: 10.1016/j.jcf.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 12/06/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
Diabetes has emerged as a major co-morbidity in cystic fibrosis (CF). The 75 g oral glucose tolerance test (OGTT) is used to screen for CF-related diabetes (CFRD) but is inconvenient, and adherence to screening is poor. The 50 g glucose challenge test (GCT) is shorter, performed non-fasting, and may serve to pre-screen the subset of individuals requiring confirmatory OGTT. We performed a pilot study in twenty-seven CF individuals across the glucose tolerance spectrum to test whether the GCT could identify subjects with abnormal glucose tolerance defined as 2-h OGTT glucose ≥7.8 mmol/L (2 h-AGT) or 1-h defined as 1-hr OGTT glucose ≥11.1 mmol/L (1 h-AGT). A GCT threshold of 8.1 mmol/L was 73% sensitive and 63% specific for 2hr-AGT and 80% sensitive and 65% specific for 1hr-AGT. Therefore, a screening GCT may reduce need for confirmatory OGTT for identifying AGT but a larger study is warranted to identify a robust cutoff for CFRD.
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Affiliation(s)
- Saba Sheikh
- Division of Pulmonary Medicine and The Cystic Fibrosis Center, The Children's Hospital of Philadelphia, Philadelphia, PA United States.
| | - A Russell Localio
- Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA United States
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA United States
| | - Ronald C Rubenstein
- Division of Pulmonary Medicine and The Cystic Fibrosis Center, The Children's Hospital of Philadelphia, Philadelphia, PA United States
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Affiliation(s)
- R E Warren
- Macleod Diabetes & Endocrine Centre, Royal Devon & Exeter Hospital, Exeter, UK
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22
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Cystic fibrosis related diabetes: Nutrition and growth considerations. J Cyst Fibros 2019; 18 Suppl 2:S32-S37. [DOI: 10.1016/j.jcf.2019.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023]
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Frost F, Dyce P, Ochota A, Pandya S, Clarke T, Walshaw MJ, Nazareth DS. Cystic fibrosis-related diabetes: optimizing care with a multidisciplinary approach. Diabetes Metab Syndr Obes 2019; 12:545-552. [PMID: 31118718 PMCID: PMC6499442 DOI: 10.2147/dmso.s180597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022] Open
Abstract
Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis and can be present in over 50% of adults with the disease. CFRD is associated with poorer clinical outcomes, including accelerated pulmonary function decline and excess morbidity. The management of CFRD is complex and differs from that of type 1 and type 2 diabetes mellitus such that clinicians responsible for the care of people with CFRD must work closely with colleagues across a number of different specialities and disciplines. This review aims to discuss why a multi-disciplinary approach is important and how it can be harnessed to optimize the care of people with CFRD.
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Affiliation(s)
- Freddy Frost
- Respiratory Medicine, Adult CF Centre, Liverpool Heart & Chest Hospital, LiverpoolL14 3PE, UK
| | - Paula Dyce
- Cystic Fibrosis Related Diabetes Service, Adult CF Centre, Liverpool Heart & Chest Hospital, LiverpoolL14 3PE, UK
| | - Alicja Ochota
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Sejal Pandya
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Thomas Clarke
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Martin J Walshaw
- Respiratory Medicine, Adult CF Centre, Liverpool Heart & Chest Hospital, LiverpoolL14 3PE, UK
| | - Dilip S Nazareth
- Respiratory Medicine, Adult CF Centre, Liverpool Heart & Chest Hospital, LiverpoolL14 3PE, UK
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Colomba J, Boudreau V, Lehoux-Dubois C, Desjardins K, Coriati A, Tremblay F, Rabasa-Lhoret R. The main mechanism associated with progression of glucose intolerance in older patients with cystic fibrosis is insulin resistance and not reduced insulin secretion capacity. J Cyst Fibros 2019; 18:551-556. [PMID: 30711385 DOI: 10.1016/j.jcf.2019.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/02/2018] [Accepted: 01/21/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Aging cystic fibrosis (CF) patients are at high risk of developing CF-related diabetes (CFRD). Decrease in insulin secretion over time is the main hypothesis to explain this increasing prevalence but mechanisms are still not well elucidated. The objective is to assess evolution of glucose tolerance and insulin secretion/sensitivity in aging CF patients. METHODS This is a retro-prospective observational analysis in the older adult CF patients from the Montreal Cystic Fibrosis Cohort (n = 46; at least 35 years old at follow-up) and followed for at least 4 years. Baseline and follow-up (last visit to date) 2-h oral glucose tolerance test (OGTT with glucose and insulin measurements every 30 min) were performed. Pulmonary function test (FEV1) and anthropometric data were measured the same day. Insulin sensitivity was measured by the Stumvoll index. RESULTS After a mean follow-up of 9.9 ± 2.6 years, mean age at follow-up was 43.5 ± 8.1 years old. An increase of body weight (+2.6 ± 6.5 kg, p = 0.01) and a decrease in pulmonary function (FEV1; 73.4 ± 21.2% to 64.5 ± 22.4%, p ≤ 0.001) were observed. Overall, insulin secretion is maintained at follow-up but all OGTT glucose values increased (for all values, p ≤ 0.028). At follow-up, 28.3% of patients had a normal glucose tolerance while 71.7% had abnormal glucose tolerance (AGT). AGT patients decreased their insulin sensitivity over time (p = 0.029) while it remained the same in NGT patients (p = 0.917). CONCLUSION In older CF patients, the progression of impaired glucose tolerance is occurring with stable insulin secretion but reduced insulin sensitivity.
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Affiliation(s)
- Johann Colomba
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada; Department of Nutrition, l'Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada
| | - Valérie Boudreau
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada; Department of Nutrition, l'Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada
| | - Catherine Lehoux-Dubois
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada; Department of Nutrition, l'Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada
| | - Katherine Desjardins
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada
| | - Adèle Coriati
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada
| | - François Tremblay
- Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montréal, QC H2X 3E4, Québec, Canada; Department of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada; Department of Nutrition, l'Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada; Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montréal, QC H2X 3E4, Québec, Canada; Department of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada.
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25
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Vongthilath R, Richaud Thiriez B, Dehillotte C, Lemonnier L, Guillien A, Degano B, Dalphin ML, Dalphin JC, Plésiat P. Clinical and microbiological characteristics of cystic fibrosis adults never colonized by Pseudomonas aeruginosa: Analysis of the French CF registry. PLoS One 2019; 14:e0210201. [PMID: 30620748 PMCID: PMC6324790 DOI: 10.1371/journal.pone.0210201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/18/2018] [Indexed: 01/13/2023] Open
Abstract
Pseudomonas aeruginosa is the main cause of chronic airway infection in cystic fibrosis (CF). However, for unclear reasons some patients are never colonized by P. aeruginosa. The objectives of this study were to better define the clinical, genetic, and microbiological characteristics of such a subpopulation and to identify predictive factors of non-colonization with P. aeruginosa. The French CF patient registry 2013–2014 was used to identify CF patients aged ≥ 20 years. The clinical outcomes, CF Transmembrane conductance Regulator (CFTR) genotypes, and microbiological data of patients reported positive at least once for P. aeruginosa (“Pyo” group, n = 1,827) were compared to those of patients with no history of P. aeruginosa isolation (“Never” group, n = 303). Predictive factors of non-colonization by P. aeruginosa were identified by multivariate logistic regression model with backward selection. Absence of aspergillosis (odds ratio (OR) [95% CI] = 1.64 [1.01–2.66]), absence of diabetes (2.25 [1.21–4.18]), pancreatic sufficiency (1.81 [1.30–2.52]), forced expiratory volume 1 (FEV1) ≥ 80% (3.03 [2.28–4.03]), older age at CF diagnosis (1.03 [1.02–1.04]), and absence of F508del/F508del genotype (2.17 [1.48–3.19]) were predictive clinical factors associated with absence of infection (“Never” group). Microbiologically, this same group was associated with more frequent detection of Haemophilus influenzae and lower rates of Stenotrophomonas maltophilia, Achromobacter xylosoxidans and Aspergillus spp. (all p<0.01) in sputum. This study strongly suggests that the absence of pulmonary colonization by P. aeruginosa in a minority of CF adults (14.2%) is associated with a milder form of the disease. Recent progress in the development of drugs to correct CFTR deficiency thus may be decisive in the control of P. aeruginosa lung infection.
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Affiliation(s)
- Réchana Vongthilath
- Department of Respiratory Medicine, University Hospital Jean Minjoz, Besançon, France
| | | | | | - Lydie Lemonnier
- Medical Department of Vaincre La Mucoviscidose, Paris, France
| | - Alicia Guillien
- Department of Physiology, University Hospital Jean Minjoz, Besançon, France
| | - Bruno Degano
- Department of Physiology, University Hospital Jean Minjoz, Besançon, France
- EA3920, University of Franche-Comté, Besançon, France
| | - Marie-Laure Dalphin
- Department of Pediatric Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Jean-Charles Dalphin
- Department of Respiratory Medicine, University Hospital Jean Minjoz, Besançon, France
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France
| | - Patrick Plésiat
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France
- Department of Bacteriology, University Hospital Jean Minjoz, Besançon, France
- * E-mail:
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26
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Brugha R, Wright M, Nolan S, Bridges N, Carr SB. Quantifying fluctuation in glucose levels to identify early changes in glucose homeostasis in cystic fibrosis. J Cyst Fibros 2018; 17:791-797. [DOI: 10.1016/j.jcf.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/21/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
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27
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Frost F, Dyce P, Nazareth D, Malone V, Walshaw MJ. Continuous glucose monitoring guided insulin therapy is associated with improved clinical outcomes in cystic fibrosis-related diabetes. J Cyst Fibros 2018; 17:798-803. [DOI: 10.1016/j.jcf.2018.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 01/08/2023]
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28
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Chan CL, Vigers T, Pyle L, Zeitler PS, Sagel SD, Nadeau KJ. Continuous glucose monitoring abnormalities in cystic fibrosis youth correlate with pulmonary function decline. J Cyst Fibros 2018; 17:783-790. [PMID: 29580828 PMCID: PMC6151303 DOI: 10.1016/j.jcf.2018.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/23/2018] [Accepted: 03/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND To characterize glucose patterns with continuous glucose monitoring (CGM) in cystic fibrosis (CF) and assess relationships between CGM and clinical outcomes. METHODS 110 CF youth and healthy controls (HC), 10-18 years, wore CGM up to 7 days. Correlations between CGM and lung function and BMI z-score change over the prior year were determined. RESULTS Multiple CGM measures were higher in CF Normal Glycemic (CFNG) youth versus HC (peak glucose, excursions >140 mg/dl/day, %time > 140 mg/dl, standard deviation (SD) and mean amplitude of glycemic excursions (MAGE)). Hypoglycemia was no different among groups. In CF, decline in FEV1% and FVC% correlated with maximum CGM glucose, excursions >200 mg/dl/day, SD, and MAGE. CONCLUSIONS CFNG youth have higher glucoses and glucose variability than HC on CGM. Higher and more variable glucoses correlate with lung function decline. Whether earlier treatment of CGM abnormalities improves lung function in CF requires further study.
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Affiliation(s)
- Christine L Chan
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Timothy Vigers
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Laura Pyle
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Philip S Zeitler
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Scott D Sagel
- Department of Pediatrics, Division of Pediatric Pulmonology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
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29
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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
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30
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Taylor-Cousar JL, Janssen JS, Wilson A, Clair CGS, Pickard KM, Jones MC, Brayshaw SJ, Chacon CS, Barboa CM, Sontag MK, Accurso FJ, Nichols DP, Saavedra MT, Nick JA. Glucose >200 mg/dL during Continuous Glucose Monitoring Identifies Adult Patients at Risk for Development of Cystic Fibrosis Related Diabetes. J Diabetes Res 2016; 2016:1527932. [PMID: 27999822 PMCID: PMC5143745 DOI: 10.1155/2016/1527932] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/30/2016] [Accepted: 11/03/2016] [Indexed: 12/31/2022] Open
Abstract
Rationale. Cystic fibrosis related diabetes (CFRD) is the most common comorbidity in patients with CF. In spite of increased screening, diagnosis, and treatment of CFRD, the mortality rate in patients with CFRD still far exceeds the mortality rate in those without CFRD. Guidelines suggest that screening for CFRD be performed annually using the 2-hour 75-gram oral glucose tolerance test (OGTT). Adherence to recommended screening has been poor, with only approximately one-quarter of adults with CF undergoing OGTT in 2014. Use of continuous glucose monitoring (CGM) for diagnosis may become an alternative. Objectives. Our objective was to determine whether abnormal CGM predicts subsequent development of CFRD, lung function, and body mass index (BMI) decline and increased rate of CF pulmonary exacerbations in adults with CF. Methods. In a prospective single center pilot trial from September 2009 to September 2010, 21 adult patients due for routine OGTT were recruited to complete simultaneous 3-day CGM and 2-hour 75 gram OGTT. Subsequently, clinical information was reviewed from 2008 to 2015. Conclusions. There was a moderate correlation between interpreted results of 2-hour OGTT and CGM (p = 0.03); CGM indicated a greater level of glucose impairment than OGTT. Glucose >200 mg/dL by CGM predicted development of CFRD (p = 0.0002).
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Affiliation(s)
- J. L. Taylor-Cousar
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
- Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
- *J. L. Taylor-Cousar:
| | - J. S. Janssen
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - A. Wilson
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - C. G. St. Clair
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - K. M. Pickard
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - M. C. Jones
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA
| | - S. J. Brayshaw
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - C. S. Chacon
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - C. M. Barboa
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - M. K. Sontag
- Colorado School of Public Health and University of Colorado, 13001 East 17th Place, Campus Box B119, Aurora, CO 80045, USA
| | - F. J. Accurso
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA
| | - D. P. Nichols
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
- Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - M. T. Saavedra
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - J. A. Nick
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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31
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Abstract
Pancreatogenic diabetes is an underdiagnosed form of secondary diabetes that is lacking official management guidelines. This paper reviews the recommended management strategies with additional data on the promising novel drugs.
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Affiliation(s)
- Jana Makuc
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
- Correspondence: Jana Makuc, General Hospital Slovenj Gradec, Gosposvetska 1, 2380 Slovenj Gradec, Slovenia, Tel +386 2 882 3582, Fax +386 2 882 3505, Email
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32
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Schindler T, Michel S, Wilson AWM. Nutrition Management of Cystic Fibrosis in the 21st Century. Nutr Clin Pract 2015; 30:488-500. [PMID: 26113561 DOI: 10.1177/0884533615591604] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Despite significant advancements made in life expectancy over the past century, cystic fibrosis remains a life-threatening genetic disease that affects the gastrointestinal tract, and it has significant impact on the nutrition status of those with the disease. Nutrition management includes a high-calorie/high-fat diet, pancreatic enzyme replacement therapy, vitamin and mineral replacement, and enteral support as needed. As patients are living longer, clinicians may encounter patients with cystic fibrosis in obstetrician offices, endocrine clinics, or hospital settings, owing to lung transplantation or for treatment for distal intestinal obstruction syndrome.
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Affiliation(s)
- Teresa Schindler
- Rainbow Babies and Children's Hospital Case Medical Center, Cleveland, Ohio
| | - Suzanne Michel
- Medical University of South Carolina, Charleston, South Carolina
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33
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Bizzarri C, Montemitro E, Pedicelli S, Ciccone S, Majo F, Cappa M, Lucidi V. Glucose tolerance affects pubertal growth and final height of children with cystic fibrosis. Pediatr Pulmonol 2015; 50:144-9. [PMID: 24678051 DOI: 10.1002/ppul.23042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/04/2014] [Indexed: 11/08/2022]
Abstract
There are few data about the impact of cystic fibrosis-related diabetes (CFRD) on growth. We analyzed 17 children with cystic fibrosis (CF) presenting with newly diagnosed CFRD during puberty, in comparison with a matched control group of 52 CF children with normal glucose tolerance (NGT). Anthropometric evaluation showed that body mass index at CFRD diagnosis was significantly reduced in children with CFRD, in comparison with children with NGT (CFRD: -0.48 ± 1.08 vs. NGT: 0.2 ± 0.99; P=0.01), and the same difference remained evident at the end of follow up (CFRD: -0.49 ± 0.95 vs. NGT: 0.13 ± 0.89; P=0.04). Height standard deviation score (SDS) at baseline was slightly but not significantly lower in CFRD children (CFRD: -0.71 ± 0.83 vs. NGT: -0.25 ± 1.08; P=0.08), while final height SDS was significantly reduced (CFRD: -1.61 ± 1.12 vs. NGT: -0.61 ± 1.15; P=0.003). Mean final height SDS of the whole group was lower than mean target height SDS (final height SDS: -0.86 ± 1.2 vs. target height SDS: -0.3 ± 0.85; P<0.001). Target adjusted final height was lower in CFRD children, although the difference between CFRD and NGT children did not reach statistical significance (CFRD: -0.8 ± 1.03 vs. NGT: -0.47 ± 0.9; P=0.09). Pubertal growth and final height are negatively affected by CFRD. Intensive insulin treatment does not appear to be effective in normalizing growth, even when treatment is started early in the course of the disease, before the onset of clinical deterioration.
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Affiliation(s)
- Carla Bizzarri
- Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Rome, Italy
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34
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Rayas MS, Willey-Courand DB, Lynch JL, Guajardo JR. Improved screening for cystic fibrosis-related diabetes by an integrated care team using an algorithm. Pediatr Pulmonol 2014; 49:971-7. [PMID: 24436252 DOI: 10.1002/ppul.22988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 12/07/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine whether implementation of a standardized, clinic-based algorithm improves compliance with cystic fibrosis-related diabetes (CFRD) screening guidelines. STUDY DESIGN A CFRD screening algorithm was developed as part of a quality improvement initiative through collaboration between the pediatric pulmonary and endocrine divisions and implemented prospectively to children aged 8-17 years in our CF center for a 6-month period. The primary outcome measure was the percentage rate of CF patients who were appropriately screened with an oral glucose tolerance test (OGTT) during the quality improvement period as compared to the year prior. RESULTS Ninety-seven percent (37/38) of OGTTs were appropriately ordered by providers, and 89% (34/38) of patients obtained the OGTT at the completion of the quality improvement period. Compared with the percentage of eligible patients completing the OGTT the year prior, the use of the algorithm significantly improved screening (P = 0.03). Data collected 1-year post-algorithm implementation revealed 97% (33/34) of OGTTs were ordered and 79% (27/34) of OGTTs were completed. The use of the algorithm 1-year post-implementation did not reveal a significant improvement in screening when compared to the reference year and implementation period (P = 0.08). CONCLUSIONS Implementation of a clinical algorithm resulted in a statistically significant improvement in screening during the quality improvement period, but this improvement was not sustained the following year despite continued physician compliance with ordering the OGTT. Barriers to patient compliance need to be explored.
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Affiliation(s)
- Maria Socorro Rayas
- Division of Pediatric Endocrinology and Diabetes, University of Texas Health Science Center in San Antonio, San Antonio, Texas
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35
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Abstract
Improved life expectancy in cystic fibrosis (CF) has led to an expanding population of adults with CF, now representing almost 50 % of the total CF population. This creates new challenges from long-term complications such as diabetes mellitus (DM), a condition that is present in 40 %-50 % of adults with CF. Cystic fibrosis-related diabetes (CFRD) results from a primary defect of insulin deficiency and although sharing features with type 1 (DM1) and type 2 diabetes (DM2), it is a clinically distinct condition. Progression to diabetes is associated with poorer CF clinical outcomes and increased mortality. CFRD is not associated with an increased risk of cardiovascular disease and the prevalence of microvascular complications is lower than DM1 or DM2. Rather, the primary goal of insulin therapy is the preservation of lung function and optimization of nutritional status. There is increasing evidence that appropriate screening and early intervention with insulin can reverse weight loss and improve pulmonary function. This approach may include targeting postprandial hyperglycemia not detected by standard diagnostic tests such as the oral glucose tolerance test. Further clinical research is required to guide when and how much to intervene in patients who are already dealing with the burden of one chronic illness.
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Affiliation(s)
- Donal O'Shea
- Department of Endocrinology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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36
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Scheuing N, Berger G, Bergis D, Gohlke B, Konrad K, Laubner K, Lilienthal E, Moser C, Schütz-Fuhrmann I, Thon A, Holl RW. Adherence to clinical care guidelines for cystic fibrosis-related diabetes in 659 German/Austrian patients. J Cyst Fibros 2014; 13:730-6. [PMID: 24917115 DOI: 10.1016/j.jcf.2014.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/10/2014] [Accepted: 05/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Germany/Austria, data on medical care for cystic fibrosis-related diabetes (CFRD) is limited. METHODS Anonymized data from 659 CFRD patients were analyzed and compared to the latest ADA/CFF guidelines. RESULTS Specialized diabetes clinics were attended less frequently than recommended (3.1 vs. 4.0 times yearly). 7.9% of patients had a complete profile of examinations: diabetes education (44.9%), HbA1c (88.8%), blood pressure (79.5%), BMI (86.5%), lipid status (37.5%), retinopathy (29.9%), microalbuminuria (33.2%), and self-monitoring of blood glucose (71.6%). HbA1c and blood pressure were measured less frequently than recommended (2.3 and 2.0 vs. 4.0 times yearly). Overall, guidelines were followed more frequently in children than adults. Contrary to recommendations, not all patients were treated with insulin (77.2 vs. 100.0%). Insulin therapy was initiated earlier in children than adults, but there was still a substantial delay (0.9 vs. 2.7years after diagnosis, p<0.001). CONCLUSION In CFRD patients studied, adherence to care guidelines was suboptimal.
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Affiliation(s)
- Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - Gabriele Berger
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Dominik Bergis
- Department of Internal Medicine I, Division of Endocrinology & Metabolism, Goethe University Hospital, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany
| | - Bettina Gohlke
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Adenauerallee 119, D-53113 Bonn, Germany
| | - Katja Konrad
- Department of Pediatrics II, University Children's Hospital Essen, Hufelandstraße 55, D-45147 Essen, Germany
| | - Katharina Laubner
- Department of Internal Medicine II, Division of Endocrinology and Diabetology, University Hospital of Freiburg, Hugstetter Straße 49, D-79106 Freiburg, Germany
| | - Eggert Lilienthal
- Department of Pediatrics, University of Bochum, Alexandrinenstraße 5, D-44791 Bochum, Germany
| | - Christine Moser
- Department of Pediatrics I, Medical University of Innsbruck, Christoph Probst Platz 1, A-6020 Innsbruck, Austria
| | - Ingrid Schütz-Fuhrmann
- 3rd Medical Department, Hospital Hietzing, Wolkersbergenstraße 1, A-1130 Vienna, Austria
| | - Angelika Thon
- Department of Pediatrics, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625 Hannover, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany
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Coriati A, Belson L, Ziai S, Haberer E, Gauthier MS, Mailhot G, Coderre L, Berthiaume Y, Rabasa-Lhoret R. Impact of sex on insulin secretion in cystic fibrosis. J Clin Endocrinol Metab 2014; 99:1767-73. [PMID: 24446654 DOI: 10.1210/jc.2013-2756] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT Cystic fibrosis-related diabetes is primarily due to a defect in insulin secretion. Women with cystic fibrosis (CF) are at higher risk of developing CF-related diabetes. OBJECTIVE The objective of the study was to examine sex differences in insulin and glucose homeostasis. We hypothesized that in CF, women would display lower insulin secretion than men. DESIGN This was a study based on an ongoing observational CF cohort with a mean follow-up of 19.9 ± 5.2 months. SETTING The study was conducted at the CF clinic of the Centre Hospitalier de l'Université de Montréal (Québec, Canada). PATIENTS From 230 adults with CF (123 men, 107 women) of similar age and functional pulmonary status, 104 retested after the follow-up. Age-matched healthy individuals (25 men, 19 women) were included in the study. INTERVENTIONS Participants underwent a 2-hour oral glucose tolerance test with 30-minute interval sample measurements. MAIN OUTCOME MEASURE Plasma insulin and glucose levels were measured. RESULTS Women with CF had higher overall insulin secretion as compared with men with CF (P ≤ .05) but similar to healthy women (P = .606). Men with CF had lower overall insulin secretion than healthy men (P = .020) and higher insulin sensitivity (P = .009) than women with CF. PATIENTS with CF displayed higher overall glucose excursions than healthy patients. Sex-related differences were still observed in the CF cohort after follow-up. CONCLUSIONS Surprisingly, in CF, adult women presented higher insulin secretion than adult men at a comparable level with what is observed in healthy individuals. Potential implications of this sex dimorphism in CF remain to be established.
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Affiliation(s)
- Adèle Coriati
- Platform for Research on Obesity, Metabolism, and Diabetes (A.C., L.B., S.Z., E.H., M.-S.G., L.C., Y.B., R.R.-L.), Metabolic Unit laboratory, Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada H2W 1R7; Department of Nutrition (A.C., L.B., S.Z., E.H., M.-S.G., G.M., R.R.-L.), Université de Montréal, Montréal, Québec, Canada H3T 1A8; Endocrinology Division (R.R.-L.), Department of Medicine, Université de Montréal, Montréal, Québec, Canada H3T1J4; Department of Medicine (L.C., Y.B., R.R.-L.), Université de Montréal, Montréal, Québec, Canada H3T1J4; Research Center (G.M.), Centre Hospitalier de l'Université Sainte-Justine, Université de Montréal, Montréal, Québec, Canada H3T 1C5; and Cystic Fibrosis Clinic (Y.B., R.R.-L.) of the Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada H2W1T8; and Montreal Diabetes Research Center (R.R.-L.), Montréal, Québec, Canada H1W4A4
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38
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Abstract
Cystic fibrosis (CF) is the most common multi-system inherited disorder, with a UK population exceeding 9,000. There have been significant improvements in CF survival over the decades, attributed to improvements in therapies available, our understanding of the disease and better organisation of care. CF care providers have been early advocates for successful healthcare transition from the paediatric to adult sector and CF can be considered a model process where a paediatric disease has now become an adult one. This article looks at the transition process in CF and the future challenges CF physicians will face.
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39
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Progression of structural lung disease on CT scans in children with cystic fibrosis related diabetes. J Cyst Fibros 2013; 12:216-21. [DOI: 10.1016/j.jcf.2012.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 09/06/2012] [Accepted: 09/21/2012] [Indexed: 11/23/2022]
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Abstract
Cystic fibrosis related diabetes (CFRD) is a common complication of cystic fibrosis, caused by a fall in insulin secretion with age in individuals with pancreatic insufficiency. CFRD is associated with worse clinical status and increased mortality. Treatment of CFRD with insulin results in sustained improvements in lung function and nutrition. While clinical experience with insulin treatment in CF has increased, the selection of who to treat and glycaemic targets remain unclear.
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41
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Martín-Frías M, Lamas Ferreiro A, Enes Romero P, Cano Gutiérrez B, Barrio Castellanos R. Alteraciones hidrocarbonadas en pacientes impúberes con fibrosis quística. An Pediatr (Barc) 2012; 77:339-43. [DOI: 10.1016/j.anpedi.2012.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 04/05/2012] [Accepted: 05/12/2012] [Indexed: 11/26/2022] Open
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42
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Bremer AA. The use of insulin in cystic fibrosis-related diabetes: a philosophical difference from the use of insulin in type 1 and type 2 diabetes. Pediatr Pulmonol 2012; 47:1039-41. [PMID: 22911489 DOI: 10.1002/ppul.22662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 07/30/2012] [Indexed: 11/07/2022]
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43
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Furgeri DT, Marson FADL, Ribeiro AF, Bertuzzo CS. Association between the IVS4G>T mutation in the TCF7L2 gene and susceptibility to diabetes in cystic fibrosis patients. BMC Res Notes 2012; 5:561. [PMID: 23050589 PMCID: PMC3519805 DOI: 10.1186/1756-0500-5-561] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 09/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical complications appear to be a decisive factor for the prognosis of patients. Diabetes is an important complication of cystic fibrosis(CF). In our study we evaluated the association between the IVS4G>T mutation in the TCF7L2 gene with the presence of diabetes in patients with CF. FINDINGS We evaluated 145 patients with CF in relation to the genotype of the IVS4G>T mutation. For this, the PCR method associated with specific enzyme digestion was used. The genotypes G/G, G/T and T/T were observed to have frequencies of 54 (37.2%), 78 (53.8%) and 13 (9%), respectively. There was no association between genotype and the occurrence of diabetes among patients. CONCLUSIONS In our sample, no association was found between the IVS4G>T mutation in the TCF7L2 gene and diabetes.
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Affiliation(s)
- Daniela Tenório Furgeri
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
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44
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Olivier AK, Yi Y, Sun X, Sui H, Liang B, Hu S, Xie W, Fisher JT, Keiser NW, Lei D, Zhou W, Yan Z, Li G, Evans TIA, Meyerholz DK, Wang K, Stewart ZA, Norris AW, Engelhardt JF. Abnormal endocrine pancreas function at birth in cystic fibrosis ferrets. J Clin Invest 2012; 122:3755-68. [PMID: 22996690 DOI: 10.1172/jci60610] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 07/26/2012] [Indexed: 01/09/2023] Open
Abstract
Diabetes is a common comorbidity in cystic fibrosis (CF) that worsens prognosis. The lack of an animal model for CF-related diabetes (CFRD) has made it difficult to dissect how the onset of pancreatic pathology influences the emergence of CFRD. We evaluated the structure and function of the neonatal CF endocrine pancreas using a new CFTR-knockout ferret model. Although CF kits are born with only mild exocrine pancreas disease, progressive exocrine and endocrine pancreatic loss during the first months of life was associated with pancreatic inflammation, spontaneous hyperglycemia, and glucose intolerance. Interestingly, prior to major exocrine pancreas disease, CF kits demonstrated significant abnormalities in blood glucose and insulin regulation, including diminished first-phase and accentuated peak insulin secretion in response to glucose, elevated peak glucose levels following glucose challenge, and variably elevated insulin and C-peptide levels in the nonfasted state. Although there was no difference in lobular insulin and glucagon expression between genotypes at birth, significant alterations in the frequencies of small and large islets were observed. Newborn cultured CF islets demonstrated dysregulated glucose-dependent insulin secretion in comparison to controls, suggesting intrinsic abnormalities in CF islets. These findings demonstrate that early abnormalities exist in the regulation of insulin secretion by the CF endocrine pancreas.
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Affiliation(s)
- Alicia K Olivier
- Department of Pathology, College of Public Health, and Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa 52242, USA
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45
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LDL-cholesterol and insulin are independently associated with body mass index in adult cystic fibrosis patients. J Cyst Fibros 2012; 11:393-7. [DOI: 10.1016/j.jcf.2012.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 02/09/2012] [Accepted: 03/14/2012] [Indexed: 11/21/2022]
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Abstract
Cystic fibrosis (CF) is an inherited chronic disease that remains a common cause of morbidity and mortality in affected patients, mostly in the young. A wealth of knowledge has been gained into the genetics, pathophysiology, and clinical manifestation of the disease. In parallel with these new insights into the disease, novel treatments have been developed or are under development that have had a major impact on quality of life and survival. Improvement in the delivery of care to patients in CF centers, using a team-based approach, and constant review of process, and by quality improvement projects, have also had an impact on outcomes in CF.
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Affiliation(s)
- Jason Lobo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, 27599-7020, USA
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47
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Insulin secretion, nutritional status and respiratory function in cystic fibrosis patients with normal glucose tolerance. Clin Nutr 2012; 31:118-23. [DOI: 10.1016/j.clnu.2011.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 01/01/2023]
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Hillman M, Eriksson L, Mared L, Helgesson K, Landin-Olsson M. Reduced levels of active GLP-1 in patients with cystic fibrosis with and without diabetes mellitus. J Cyst Fibros 2011; 11:144-9. [PMID: 22138561 DOI: 10.1016/j.jcf.2011.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/01/2011] [Accepted: 11/08/2011] [Indexed: 12/21/2022]
Abstract
Glucagon like peptide 1 (GLP-1) is an incretin hormone released as a bioactive peptide from intestinal L-cells in response to eating. It acts on target cells and exerts several functions as stimulating insulin and inhibiting glucagon. It is quickly deactivated by the serine protease dipeptidyl peptidase IV (DPP-IV) as an important regulatory mechanism. GLP-1 analogues are used as antidiabetic drugs in patients with type 2 diabetes. We served patients with cystic fibrosis (CF, n=29), cystic fibrosis related diabetes (CFRD, n=19) and healthy controls (n=18) a standardized breakfast (23 g protein, 25 g fat and 76 g carbohydrates) after an overnight fasting. Blood samples were collected before meal as well as 15, 30, 45 and 60 min after the meal in tubes prefilled with a DPP-IV inhibitor. The aim of the study was to compare levels of GLP-1 in patients with CF, CFRD and in healthy controls. We found that active GLP-1 was significantly decreased in patients with CF and CFRD compared to in healthy controls (p<0.01). However, levels in patients with CFRD tended to be lower but were not significantly lower than in patients with CF without diabetes (p=0.06). Total GLP-1 did not differ between the groups, which points to that the inactive form of GLP-1 is more pronounced in CF patients. The endogenous insulin production (measured by C-peptide) was significantly lower in patients with CFRD as expected. However, levels in non-diabetic CF patients did not differ from the controls. We suggest that the decreased levels of GLP-1 could affect the progression toward CFRD and that more studies need to be performed in order to evaluate a possible treatment with GLP-1 analogues in CF-patients.
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Affiliation(s)
- Magnus Hillman
- Department of Clinical Sciences, Biomedical Center, Lund University, Sweden.
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49
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The complex exocrine-endocrine relationship and secondary diabetes in exocrine pancreatic disorders. J Clin Gastroenterol 2011; 45:850-61. [PMID: 21897283 DOI: 10.1097/mcg.0b013e31822a2ae5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The pancreas is a dual organ with exocrine and endocrine functions. The interrelationship of the endocrine-exocrine parts of the pancreas is a complex one, but recent clinical and experimental studies have expanded our knowledge. Many disorders primarily of the exocrine pancreas, often solely in the clinical realm of gastroenterologists are associated with diabetes mellitus (DM). Although, the DM becoming disorders are often grouped with type 2 diabetes, the pathogenesis, clinical manifestations and management differ. We review here data on the association of exocrine-endocrine pancreas, the many hormones of the pancreas and their possible effects on the exocrine functions followed by data on the epidemiology, pathogenesis, and management of DM in chronic pancreatitis, cystic fibrosis, pancreatic cancer, and clinical states after pancreatic surgery.
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50
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Martín-Frías M, Máiz L, Carcavilla A, Barrio R. Long-term benefits in lung function and nutritional status of strict metabolic control of cystic fibrosis-related diabetes. Arch Bronconeumol 2011; 47:531-4. [PMID: 21798655 DOI: 10.1016/j.arbres.2011.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 05/10/2011] [Accepted: 06/01/2011] [Indexed: 12/01/2022]
Abstract
Cystic fibrosis related diabetes (CFRD) is a strong determinant for lung function decline and increased mortality. Insulin treatment of CFRD is reportedly beneficial for this situation. We report on the long-term impact of insulin treatment of CFRD on pulmonary function and nutritional status in a CF male patient since diagnosis of diabetes. We report the case of a patient diagnosed with CF at the age of 16. Two years later, he experienced a rapidly evolving decrease in pulmonary function, some months later criteria were met warranting lung transplantation. Concomitantly, he was diagnosed with CFRD and insulin therapy was started. Lung function (spirometry), nutritional status (body mass index) and metabolic control (HbA(1c)) were determined every 3 months. After the introduction of insulin treatment, pulmonary function and nutritional status progressively improved and good glycemic control was achieved. The significant and sustained improvement in pulmonary function allowed for the patient's withdrawal from the lung transplantation program within 4 months, a situation which has been maintained until now, 8 years later. The long follow-up of our patient documents the rapid and prolonged beneficial effect of proper metabolic control of CFRD on the respiratory deterioration in CF.
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Affiliation(s)
- María Martín-Frías
- Unidad de Diabetes Pediátrica, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, España.
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