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Rakotoarisoa L, Weiss L, Lefebvre F, Porzio M, Renaud-Picard B, Ravoninjatovo B, Abely M, Danner-Boucher I, Dubois S, Troussier F, Prevotat A, Rault G, Kessler R, Kessler L. Early glucose abnormalities revealed by continuous glucose monitoring associate with lung function decline in cystic fibrosis: A five-year prospective study. J Diabetes Complications 2024; 38:108703. [PMID: 38430625 DOI: 10.1016/j.jdiacomp.2024.108703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Cystic fibrosis related diabetes (CFRD) is commonly associated with declining lung function and nutritional status. We aimed to evaluate the pulmonary impact of early glucose abnormalities by using 2-h standard oral glucose tolerance testing (OGTT) and continuous glucose monitoring (CGM) in people with cystic fibrosis (PwCF). METHODS PwCF aged ≥10 years old without known CFRD were included in a five-year prospective multicentre study. Annual evaluation of nutritional status, lung function, OGTT and CGM was set up. Associations between annual rate changes (Δ) in lung function, ΔFEV1 (forced expiratory volume in 1 s) percentage predicted (pp) and ΔFVC (forced vital capacity) pp., and annual rate changes in OGTT or CGM variables were estimated with a mixed model with a random effect for subject. RESULTS From 2009 to 2016, 112 PwCF (age: 21 ± 11 years, BMI (body mass index) z-score: -0.55 ± 1.09, FEV1pp: 77 ± 24 %, 2-h OGTT glucose: 122 ± 44 mg/dL, AUC (area under curve) >140 mg/dL: 1 mg/dL/day (0.2, 3.0) were included. A total of 428 OGTTs and 480 CGMs were collected. The participants presented annual decline of FVCpp and FEV1pp at -1.0 % per year (-1.6, -0.4), p < 0.001 and - 1.9 % per year (-2.5, -1.3), p < 0.001 respectively without change in BMI z-score during the study. Variation of two-hour OGTT glucose was not associated with declining lung function, as measured by ΔFEV1pp (p = 0.94) and ΔFVCpp (p = 0.90). Among CGM variables, only increase in AUC >140 mg/dL between two annual visits was associated with a decrease in ΔFVCpp (p < 0.05) and ΔFEV1pp (p < 0.05). CONCLUSIONS This prospective study supports the fact that early glucose abnormalities revealed by CGM predict pulmonary function decline in PwCF, while 2-h standard OGTT glucose is not associated with pulmonary impairment.
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Affiliation(s)
- Luc Rakotoarisoa
- Department of Endocrinology, Diabetes and Nutrition, Strasbourg University Hospital, France; Adult Cystic Fibrosis Centre, Strasbourg University Hospital, France; UMR Inserm 1260, Regenerative Nanomedicine, University of Strasbourg, France
| | - Laurence Weiss
- Pediatric Cystic Fibrosis Centre, Strasbourg University Hospital, France
| | - François Lefebvre
- Group of Methodology in Clinical Research (GMRC), Strasbourg University Hospital, France
| | - Michele Porzio
- Adult Cystic Fibrosis Centre, Strasbourg University Hospital, France; Department of Pneumology, Strasbourg University Hospital, France
| | - Benjamin Renaud-Picard
- Adult Cystic Fibrosis Centre, Strasbourg University Hospital, France; UMR Inserm 1260, Regenerative Nanomedicine, University of Strasbourg, France; Department of Pneumology, Strasbourg University Hospital, France
| | | | - Michel Abely
- Cystic Fibrosis Centre, Reims University Hospital Centre, France
| | | | | | | | - Anne Prevotat
- Cystic Fibrosis Centre, Lille University Hospital, France
| | - Gilles Rault
- Cystic Fibrosis Centre of Perharidy, Roscoff, France
| | - Romain Kessler
- Adult Cystic Fibrosis Centre, Strasbourg University Hospital, France; UMR Inserm 1260, Regenerative Nanomedicine, University of Strasbourg, France; Department of Pneumology, Strasbourg University Hospital, France
| | - Laurence Kessler
- Department of Endocrinology, Diabetes and Nutrition, Strasbourg University Hospital, France; Adult Cystic Fibrosis Centre, Strasbourg University Hospital, France; UMR Inserm 1260, Regenerative Nanomedicine, University of Strasbourg, France.
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Kocaaga E, Inal-Ince D, Dogru D, Alikasifoglu A, Ademhan-Tural D, Bozdemir-Ozel C, Calik-Kutukcu E, Saglam M, Vardar-Yagli N, Emiralioglu N. Exercise performance in children and adolescents with cystic fibrosis with and without abnormal glucose tolerance: a single center cross-sectional study. Physiother Theory Pract 2024; 40:230-240. [PMID: 36043898 DOI: 10.1080/09593985.2022.2116300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Abnormal glucose tolerance (AGT) in cystic fibrosis (CF) affects lung function and clinical parameters, including aerobic fitness. However, its effects on physical activity level (PAL), anaerobic power (AP), and muscle strength (MS) in children and adolescents are unknown. PURPOSE To investigate aerobic fitness, PAL, AP, and MS in pediatric patients with mild-to-moderate CF and AGT. METHODS The study included children and adolescents with CF aged 10-18 years. Participants underwent a pulmonary function test, quadriceps, and handgrip MS measurement, vertical jump test to assess AP, and six-minute walk test (6MWT) to assess aerobic fitness. Bouchard's Three-Day Physical Activity record was used to determine PAL. RESULTS Height z-score (p = .006), 6MWT (p = .024), handgrip (p = .028), quadriceps MS (p = .044), and AP (p = .036) were significantly lower in AGT (n = 21) than normal glucose tolerance (NGT) (n = 19). In the AGT group, glycosylated hemoglobin (HbA1c) was significantly associated with forced expiratory volume in one second (FEV1) (p = .046). 6MWT distance (6MWD) was associated with height (p = .008), FEV1 (p = .001), forced vital capacity (FVC) (p = .001), forced expiratory flow from 25% to 75% (FEF25-75%) (p = .030), handgrip MS (p = .012), and PAL (p = .034). After adjusting for height and FEV1, the groups had similar 6MWD, MS, and AP (p > .05); also, insulin was associated with MS and AP but not with 6MWT or quadriceps MS. CONCLUSION Measures of aerobic fitness, MS, and AP are lower in AGT, but after adjusting for height and FEV1, aerobic fitness, MS, and AP do not show substantial differences. Insulin sensitivity and resistance are associated with MS and AP.
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Affiliation(s)
- Elif Kocaaga
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Deniz Dogru
- Faculty of Medicine, Department of Pediatric Chest Medicine, Sihhiye Campus, Hacettepe University, Ankara, Turkey
| | - Ayfer Alikasifoglu
- Faculty of Medicine, Department of Pediatric Endocrinology, Sihhiye Campus, Hacettepe University, Ankara, Turkey
| | - Dilber Ademhan-Tural
- Faculty of Medicine, Department of Pediatric Chest Medicine, Sihhiye Campus, Hacettepe University, Ankara, Turkey
| | - Cemile Bozdemir-Ozel
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Meselik Campus, Eskisehir Osman Gazi University, Odunpazarı, Eskisehir, Turkey
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Nagehan Emiralioglu
- Faculty of Medicine, Department of Pediatric Chest Medicine, Sihhiye Campus, Hacettepe University, Ankara, Turkey
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Olivença DV, Davis JD, Kumbale CM, Zhao CY, Brown SP, McCarty NA, Voit EO. Mathematical models of cystic fibrosis as a systemic disease. WIREs Mech Dis 2023; 15:e1625. [PMID: 37544654 PMCID: PMC10843793 DOI: 10.1002/wsbm.1625] [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: 12/16/2022] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023]
Abstract
Cystic fibrosis (CF) is widely known as a disease of the lung, even though it is in truth a systemic disease, whose symptoms typically manifest in gastrointestinal dysfunction first. CF ultimately impairs not only the pancreas and intestine but also the lungs, gonads, liver, kidneys, bones, and the cardiovascular system. It is caused by one of several mutations in the gene of the epithelial ion channel protein CFTR. Intense research and improved antimicrobial treatments during the past eight decades have steadily increased the predicted life expectancy of a person with CF (pwCF) from a few weeks to over 50 years. Moreover, several drugs ameliorating the sequelae of the disease have become available in recent years, and notable treatments of the root cause of the disease have recently generated substantial improvements in health for some but not all pwCF. Yet, numerous fundamental questions remain unanswered. Complicating CF, for instance in the lung, is the fact that the associated insufficient chloride secretion typically perturbs the electrochemical balance across epithelia and, in the airways, leads to the accumulation of thick, viscous mucus and mucus plaques that cannot be cleared effectively and provide a rich breeding ground for a spectrum of bacterial and fungal communities. The subsequent infections often become chronic and respond poorly to antibiotic treatments, with outcomes sometimes only weakly correlated with the drug susceptibility of the target pathogen. Furthermore, in contrast to rapidly resolved acute infections with a single target pathogen, chronic infections commonly involve multi-species bacterial communities, called "infection microbiomes," that develop their own ecological and evolutionary dynamics. It is presently impossible to devise mathematical models of CF in its entirety, but it is feasible to design models for many of the distinct drivers of the disease. Building upon these growing yet isolated modeling efforts, we discuss in the following the feasibility of a multi-scale modeling framework, known as template-and-anchor modeling, that allows the gradual integration of refined sub-models with different granularity. The article first reviews the most important biomedical aspects of CF and subsequently describes mathematical modeling approaches that already exist or have the potential to deepen our understanding of the multitude aspects of the disease and their interrelationships. The conceptual ideas behind the approaches proposed here do not only pertain to CF but are translatable to other systemic diseases. This article is categorized under: Congenital Diseases > Computational Models.
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Affiliation(s)
- Daniel V. Olivença
- Center for Engineering Innovation, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, USA
| | - Jacob D. Davis
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia
| | - Carla M. Kumbale
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia
| | - Conan Y. Zhao
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Samuel P. Brown
- Department of Biological Sciences, Georgia Tech and Emory University, Atlanta, Georgia
| | - Nael A. McCarty
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Eberhard O. Voit
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia
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Potter KJ, Racine F, Bonhoure A, Boudreau V, Bélanger N, Coriati A, Shohoudi A, Lavoie A, Senior PA, Mailhot G, Rabasa-Lhoret R. A glycosylated hemoglobin A1c above 6% (42 mmol/mol) is associated with a high risk of developing Cystic Fibrosis-Related Diabetes and a lower probability of weight gain in both adults and children with Cystic Fibrosis. DIABETES & METABOLISM 2023; 49:101455. [PMID: 37271306 DOI: 10.1016/j.diabet.2023.101455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The classical glycosylated hemoglobin A1c threshold of 6.5% is an insensitive screening test for cystic fibrosis-related diabetes (CFRD). We sought to identify CF-specific A1C thresholds associated with 1) risk of progression to CFRD and 2) changes in body mass index (BMI) and forced expiratory volume (FEV1). METHODS We studied the cross sectional and longitudinal associations between A1c, BMI, and FEV1 in 2 cohorts of 223 children (followed for up to 8 years) and 289 adults (followed for a mean of 7.5 ± 4.3 years) with CF but without diabetes at baseline and undergoing regular assessments including Oral Glucose Tolerance Test (OGTT). RESULTS For the onset of OGTT-defined CFRD optimal A1c threshold was 5.9% in adults (sensitivity: 67% and specificity: 71%) and 5.7% for children (sensitivity: 60% and specificity: 47%). Kaplan-Meier analysis of progression to CFRD according to baseline A1C showed increased the risk of developing CFRD for A1c ≥ 6.0% in adults (P = 0.002) and ≥ 5.5% in children (p = 0.012). Temporal changes in BMI and FEV1 according to baseline A1C in adults were assessed with a linear mixed-effect model, BMI significantly increased over time in subjects with a baseline A1c < 6%, but those with a A1C ≥ 6.0% gained significantly less weight over time (P = 0.05). There was no difference in FEV1 according to baseline A1c category. CONCLUSION An A1C above 6% may be associated with a high risk of developing CFRD and a lower probability of weight gain in both adults and children with CF.
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Affiliation(s)
- Kathryn J Potter
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Florence Racine
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Anne Bonhoure
- 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
| | - Noémie Bélanger
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Adèle Coriati
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Azadeh Shohoudi
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Annick Lavoie
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Peter A Senior
- Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Geneviève Mailhot
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Division of Nutrition and Endocrinology, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
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Weiss L, Reix P, Mosnier-Pudar H, Ronsin O, Beltrand J, Reynaud Q, Mely L, Burgel PR, Stremler N, Rakotoarisoa L, Galderisi A, Perge K, Bendelac N, Abely M, Kessler L. Screening strategies for glucose tolerance abnormalities and diabetes in people with cystic fibrosis. DIABETES & METABOLISM 2023; 49:101444. [PMID: 37030530 DOI: 10.1016/j.diabet.2023.101444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/21/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
The increase in life expectancy of patients with cystic fibrosis has come with new comorbidities, particularly diabetes. The gradual development of glucose tolerance abnormalities means that 30 to 40% of adults will be diabetic. Cystic fibrosis-related diabetes is a major challenge in the care of these patients because it is a morbidity and mortality factor at all stages of the disease. Early glucose tolerance abnormalities observed from childhood, before the stage of diabetes, are also associated with a poor pulmonary and nutritional outcome. The long asymptomatic period justifies systematic screening with an annual oral glucose tolerance test from the age of 10 years. However, this strategy does not take into account the new clinical profiles of patients with cystic fibrosis, recent pathophysiological knowledge of glucose tolerance abnormalities, and the emergence of new diagnostic tools in diabetology. In this paper, we summarise the challenges of screening in the current context of new patient profiles - patients who are pregnant, have transplants, or are being treated with fibrosis conductance transmembrane regulator modulators - and put forward an inventory of the various screening methods for cystic fibrosis-related diabetes, including their applications, limitations and practical implications.
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Canadian Cystic Fibrosis-related Diabetes Clinical Practice Survey: Analysis of Current Practices and Gaps in Clinical Care. Can J Diabetes 2023; 47:263-271.e1. [PMID: 36872137 DOI: 10.1016/j.jcjd.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES Our aim in this study was to identify challenges and gaps in Canadian practices in screening, diagnosis and treatment of cystic fibrosis-related diabetes (CFRD), with the goal of informing a Canadian-specific guideline for CFRD. METHODS We conducted an online survey of health-care professionals (97 physicians and 44 allied health professionals) who care for people living with CF (pwCF) and/or CFRD (pwCFRD). RESULTS Most pediatric centres followed <10 pwCFRD and adult centres followed >10 pwCFRD. Children with CFRD are usually followed at a separate diabetes clinic, whereas adults with CFRD may be followed by respirologists, nurse practitioners or endocrinologists in CF clinic or in a separate diabetes clinic. Less than 25% of pwCF had access to an endocrinologist with a special interest or expertise in CFRD. Many centres perform screening oral glucose tolerance testing with fasting and 2-hour time-points. Respondents, especially those working with adults, also indicate use of additional tests for screening not currently recommended in CFRD guidelines. Pediatric practitioners tend to only use insulin to manage CFRD, whereas adult practitioners are more likely to use repaglinide as an alternative to insulin. CONCLUSIONS Access to specialized CFRD care may be a challenge for pwCFRD in Canada. There appears to be wide heterogeneity of CFRD care organization, screening and treatment among health-care providers caring for pwCF and/or CFRD across Canada. Practitioners working with adult pwCF are less likely to adhere to current clinical practice guidelines than practitioners working with children.
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Declercq D, Helleputte S, Marchand S, Van Aken S, Van Braeckel E, Van Daele S, T'Sjoen G, Van Biervliet S, Lapauw B. Glycemic indices at night measured by CGM are predictive for a lower pulmonary function in adults but not in children with cystic fibrosis. J Cyst Fibros 2023; 22:59-65. [PMID: 36068119 DOI: 10.1016/j.jcf.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/17/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In patients with cystic fibrosis (CF), it is still unclear to which extent glucose abnormalities - preceding the diagnosis of cystic fibrosis related diabetes (CFRD) - are associated with pulmonary and nutritional outcome parameters. This study related circadian glycemic patterns to clinical outcomes in a group of CF patients not previously diagnosed with diabetes. METHODS Continuous glucose monitoring (CGM) readings (7 days) of 47 CF patients (26 children, 21 adults) with an impaired oral glucose tolerance test (OGTT) (n = 25) and/or increased Hb1Ac (> 5.5%) were analyzed. Biometric, pulmonary function and clinical parameters were retrospectively collected over a period of 1 year before (T-1) and 1 year after (T + 1) CGM (T0). RESULTS 96% (45/47) of CGM readings showed glucose values > 140 mg/dL ≥ 4.5% of the time and at least one ≥ 200 mg/dL. In the pediatric cohort, no significant associations were found between CGM parameters and pulmonary and nutritional outcome parameters. In the adult cohort, an area under the curve (AUC) > 140 mg/dL and%-time > 140 mg/dL during the night were associated with a lower forced expiratory volume in 1 s (FEV1)% predicted (pp) at time of evaluation but not with change in FEV1pp. CONCLUSION This is the first study reporting the circadian glycemic pattern in children and adults at risk for CFRD. In the adult cohort an association between detection of abnormal glucose exposure and a lower FEV1pp was found. Our results support continued screening for glucose intolerance in patients with CF.
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Affiliation(s)
- Dimitri Declercq
- Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium; Department of Pediatrics, Centre for Children and Adolescents with Diabetes, Ghent University Hospital, Ghent, Belgium; Centre for Nutrition and Dietetics, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Simon Helleputte
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Sophie Marchand
- Centre for Nutrition and Dietetics, Ghent University Hospital, Ghent, Belgium.
| | - Sara Van Aken
- Department of Pediatrics, Centre for Children and Adolescents with Diabetes, Ghent University Hospital, Ghent, Belgium.
| | - Eva Van Braeckel
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium.
| | - Sabine Van Daele
- Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Guy T'Sjoen
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
| | - Stephanie Van Biervliet
- Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Bruno Lapauw
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
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Welter JJ, Lennox AT, Krishnan S, Kim C, Krishnan S, Thompson H, McAllister E, Huang K, Nwaedozie K, Dozor AJ. The relationship between weight and pulmonary outcomes in overweight and obese people with cystic fibrosis: A retrospective observational study. Health Sci Rep 2022; 5:e910. [PMID: 36320654 PMCID: PMC9616171 DOI: 10.1002/hsr2.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 09/09/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background A major focus in cystic fibrosis (CF) care aims to increase weight gain. Rates of overweight and obese people with CF have gradually increased over the past decade. Obesity could be a risk for restriction of lung volumes and airway obstruction as well as increase rates of pulmonary exacerbations in people with CF. Aim To assess the relationship between weight categories and pulmonary outcomes in children and adults with CF. Methods Patients 6 years of age and older were categorized into weight categories based on the Centers for Disease Control and Prevention (CDC) definitions. A retrospective chart review was conducted to obtain lung function testing and other outcomes. Results One hundred five patients with a median age of 20.6 years were included in this analysis. 8.4%, 64%, 18%, and 10% of patients were underweight, normal/healthy weight, overweight, and obese, respectively. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) (% predicted) did not differ between patients with weights in the normal range versus patients in the overweight/obese categories. Linear regression analysis showed a direct correlation between body mass index (BMI) and FEV1 that continued as BMI entered overweight and obese categories in both pediatric and adult patients. Overweight/obese patients did not have increased rates of pulmonary exacerbations compared to those in the normal/healthy weight category. Conclusion As CF therapies continue to improve, an increasing number of people with CF are exceeding the CDC's normal-weight range. Gaining weight past the normal range does not appear to negatively impact pulmonary health of people with CF. If this trend of increased weight gain continues, it remains to be seen if it will eventually negatively affect lung health.
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Affiliation(s)
- John J. Welter
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
| | - Alison T. Lennox
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
| | - Sankaran Krishnan
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
| | - Christy Kim
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
| | | | - Haley Thompson
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
| | - Emily McAllister
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
| | - Kristen Huang
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
| | - Kasiemobi Nwaedozie
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
| | - Allen J. Dozor
- Division of Pediatric PulmonologyNew York Medical CollegeValhallaNew YorkUSA
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9
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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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10
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Auxological and Endocrinological Features in Children and Adolescents with Cystic Fibrosis. J Clin Med 2022; 11:jcm11144041. [PMID: 35887806 PMCID: PMC9323690 DOI: 10.3390/jcm11144041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Cystic fibrosis (CF) is a multisystem autosomal recessive disease caused by mutations that lead to deficient or dysfunctional CF transmembrane conductance regulator (CFTR) proteins. Patients typically present malnutrition resulting from the malabsorption of fundamental nutrients and recurring lung infections, with a progressive worsening of the respiratory function. For these reasons, the clinical management of CF requires a multidisciplinary team. From an endocrinological point of view, patients often present major complications, such as diabetes, bone disease, thyroid disorders, delayed growth and puberty, hypogonadism and infertility, which negatively affect their quality of life and, in some cases, significantly reduce life expectancy. These complications can arise as a direct result of CFTR dysfunction and/or as a consequence of a deterioration in the function of the organs affected. The objective of this review is to analyze all the possible endocrinological complications that can occur in patients with CF by evaluating the most recent papers in the literature.
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11
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H E, CR H, S D, EA E. 2D Shear Wave Elastography, a promising screening tool for Cystic Fibrosis liver disease, shows a correlation between vitamin D and liver stiffness. J Cyst Fibros 2022; 21:873-877. [DOI: 10.1016/j.jcf.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/24/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
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12
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Affiliation(s)
- Aleksandar Sovtic1,2
- 1. Department of Pulmonology, Mother and Child Health Institute of Serbia, Belgrade, Serbia. 2. School of Medicine, University of Belgrade, Belgrade, Serbia
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13
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Rachel M, Biesiadecki M, Galiniak S. Cystic Fibrosis-Related Diabetes in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074069. [PMID: 35409752 PMCID: PMC8998285 DOI: 10.3390/ijerph19074069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023]
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive inherited monogenic disease in Caucasians. As medical technology progresses and the quality of patient care improves, the survival time of patients with CF has increased, which results in more frequent comorbidities such as cystic fibrosis-related diabetes (CFRD). CFRD is the result of abnormal glucose metabolism characterized primarily by insulin deficiency, exacerbated periodically by insulin resistance. The aim of our study was to analyze the epidemiology of patients with CFRD in Poland on the basis of data collected from six CF treatment centers. Analyses were performed on 1157 CF patients who were treated at one of the six CF care centers. CFRD was diagnosed according to standard criteria. All data including demographics, types of CFTR mutations, CFRD duration, and microorganisms in the sputum were obtained from the patients’ medical history. Our study indicates that the prevalence of CFRD in Poland is 12.9%. CFRD was most often diagnosed between the ages of 11 and 20 (60% of patients), while 23% of patients were diagnosed between 21 and 30 years of age. Furthermore, we observed that approximately 3–5% of patients under the age of 10 had CFRD. We found out that the type of mutation did not affect the frequency of CFRD development. Factors that increased the risk of developing CFRD include underweight and chronic Pseudomonas aeruginosa infection. Due to the extended lifespan of CF patients, the number of CFRD patients is currently increasing. We believe that the results of our study may complement information from other studies or may be useful in planning health policy in Poland.
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Affiliation(s)
- Marta Rachel
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (S.G.)
- Department of Allergology and Cystic Fibrosis, State Hospital 2 in Rzeszow, Lwowska 60, 35-301 Rzeszów, Poland
- Correspondence: ; Tel.: +48-17-866-46-67
| | - Marek Biesiadecki
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (S.G.)
| | - Sabina Galiniak
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (S.G.)
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14
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Most Short Children with Cystic Fibrosis Do Not Catch Up by Adulthood. Nutrients 2021; 13:nu13124414. [PMID: 34959966 PMCID: PMC8703459 DOI: 10.3390/nu13124414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/23/2022] Open
Abstract
Poor linear growth is common in children with cystic fibrosis (CF) and predicts pulmonary status and mortality. Growth impairment develops in infancy, prior to pulmonary decline and despite aggressive nutritional measures. We hypothesized that growth restriction during early childhood in CF is associated with reduced adult height. We used the Cystic Fibrosis Foundation (CFF) patient registry to identify CF adults between 2011 and 2015 (ages 18–19 y, n = 3655) and had height for age (HFA) records between ages 2 and 4 y. We found that only 26% CF adults were ≥median HFA and 25% were <10th percentile. Between 2 and 4 years, those with height < 10th percentile had increased odds of being <10th percentile in adulthood compared to children ≥ 10th percentile (OR = 7.7). Of HFA measured between the 10th and 25th percentiles at ages 2–4, 58% were <25th percentile as adults. Only 13% between the 10th and 25th percentile HFA at age 2–4 years were >50th percentile as adults. Maximum height between ages 2 and 4 highly correlated with adult height. These results demonstrate that low early childhood CF height correlates with height in adulthood. Since linear growth correlates with lung growth, identifying both risk factors and interventions for growth failure (nutritional support, confounders of clinical care, and potential endocrine involvement) could lead to improved overall health.
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15
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Ararat E, Sonawalla A, Berlinski A, Tas E. Nutritional status between 5-10 years is associated with cystic fibrosis-related diabetes in adolescence. Pediatr Pulmonol 2021; 56:3217-3222. [PMID: 34245493 DOI: 10.1002/ppul.25572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cystic fibrosis-related diabetes (CFRD) is a risk factor for adverse clinical outcomes including poor nutritional status, deterioration in lung functions, and increased mortality. The association between nutritional status between 5 and 10 years of age and later diagnosis of CFRD is not known. METHODS A retrospective chart review was performed for our patients with CF between 10 and 18 years. Data was collected at age 5 and 10 years. Comparison made between patients with and without CFRD. RESULTS Two groups were comparable for age and sex. At age 5, groups had no differences in weight, height, and body mass index. At age 10, the CFRD group had a lower body mass index (40.2 ± 24.7 vs. 61.5 ± 22.5 percentile, p = 0.02). Spirometry was similar between groups at 5 and 10 years. Patients with CFRD had lower growth velocity (5 ± 0.9 vs. 5.7 ± 0.9 cm/year, p = 0.03) and reduced weight gain rate (2.2 ± 0.9 vs. 3.2 ± 1.2 kg/year, p = 0.03) compared to patients without CFRD between 5 and 10 years. Patients with a weight gain less than 2.5 kg/year between 5 and 10 years were nine times more likely to develop CFRD in adolescence (Unadjusted Odds Ratio: 8.9; 95% CI:1.4, 47.2; p = 0.01). CONCLUSION Patients who later developed CFRD had significantly lower weight gain rate and height growth between 5 and 10 years of age than those without diabetes. Close monitoring of nutritional status in before age 10 years may help identify CF patients at-risk of developing CFRD.
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Affiliation(s)
- Erhan Ararat
- Division of Pulmonology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ambreen Sonawalla
- Department of Pediatrics, Graduate Medical Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ariel Berlinski
- Division of Pulmonology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Emir Tas
- Division of Endocrinology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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16
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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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17
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Glycated Hemoglobin as a First-line Screening Test for Cystic Fibrosis‒Related Diabetes and Impaired Glucose Tolerance in Children With Cystic Fibrosis: A Validation Study. Can J Diabetes 2021; 45:768-774. [PMID: 33926819 DOI: 10.1016/j.jcjd.2021.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Our aims in this study were to document the screening rate for cystic fibrosis‒related diabetes (CFRD) in children followed at a cystic fibrosis (CF) clinic in Canada and to evaluate the accuracy of various glycated hemoglobin (A1C) cutoffs to screen for CFRD and impaired glucose tolerance (IGT) in a pediatric CF population. METHODS The CFRD screening rate was calculated over a follow-up period of up to 8 years among children who attended the CF clinic between 1993 and 2018. Test performance of A1C at various thresholds ranging from 5.5% to 6.2% was compared with the oral glucose tolerance test (OGTT) as the reference method. Children with CF aged ≥10 years with an OGTT performed within 120 days of A1C measurement were included in the analysis. RESULTS The overall CFRD screening rate was 53.0%. A total of 256 children were included for the A1C performance analysis, of whom 8.6% had an OGTT-confirmed CFRD diagnosis. An A1C threshold of 5.8% demonstrated an optimal balance between sensitivity (90.9%) and specificity (60.7%) for CFRD screening, leading to a potential reduction of 56.3% of the annual required OGTTs. A1C demonstrated poor accuracy for identifying children with IGT. CONCLUSIONS An A1C threshold ≥5.8% allows for identification of children requiring further CFRD investigations, which may reduce the clinical burden of children with CF without compromising the ability of early CFRD diagnosis.
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18
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Iafusco F, Maione G, Rosanio FM, Mozzillo E, Franzese A, Tinto N. Cystic Fibrosis-Related Diabetes (CFRD): Overview of Associated Genetic Factors. Diagnostics (Basel) 2021; 11:diagnostics11030572. [PMID: 33810109 PMCID: PMC8005125 DOI: 10.3390/diagnostics11030572] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/19/2021] [Indexed: 12/21/2022] Open
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disease in the Caucasian population and is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene that encodes for a chloride/bicarbonate channel expressed on the membrane of epithelial cells of the airways and of the intestine, as well as in cells with exocrine and endocrine functions. A common nonpulmonary complication of CF is cystic fibrosis-related diabetes (CFRD), a distinct form of diabetes due to insulin insufficiency or malfunction secondary to destruction/derangement of pancreatic betacells, as well as to other factors that affect their function. The prevalence of CFRD increases with age, and 40–50% of CF adults develop the disease. Several proposed hypotheses on how CFRD develops have emerged, including exocrine-driven fibrosis and destruction of the entire pancreas, as well as contrasting theories on the direct or indirect impact of CFTR mutation on islet function. Among contributors to the development of CFRD, in addition to CFTR genotype, there are other genetic factors related and not related to type 2 diabetes. This review presents an overview of the current understanding on genetic factors associated with glucose metabolism abnormalities in CF.
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Affiliation(s)
- Fernanda Iafusco
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, 80131 Naples, Italy; (F.I.); (G.M.)
- CEINGE Advanced Biotechnology, 80131 Naples, Italy
| | - Giovanna Maione
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, 80131 Naples, Italy; (F.I.); (G.M.)
- CEINGE Advanced Biotechnology, 80131 Naples, Italy
| | - Francesco Maria Rosanio
- Regional Center of Pediatric Diabetology, Department of Translational Medical Sciences, Section of Pediatrics, University of Naples “Federico II”, 80131 Naples, Italy; (F.M.R.); (E.M.); (A.F.)
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetology, Department of Translational Medical Sciences, Section of Pediatrics, University of Naples “Federico II”, 80131 Naples, Italy; (F.M.R.); (E.M.); (A.F.)
| | - Adriana Franzese
- Regional Center of Pediatric Diabetology, Department of Translational Medical Sciences, Section of Pediatrics, University of Naples “Federico II”, 80131 Naples, Italy; (F.M.R.); (E.M.); (A.F.)
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, 80131 Naples, Italy; (F.I.); (G.M.)
- CEINGE Advanced Biotechnology, 80131 Naples, Italy
- Correspondence:
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19
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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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20
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Elidottir H, Diemer S, Eklund E, Hansen CR. Abnormal glucose tolerance and lung function in children with cystic fibrosis. Comparing oral glucose tolerance test and continuous glucose monitoring. J Cyst Fibros 2021; 20:779-784. [PMID: 33478894 DOI: 10.1016/j.jcf.2021.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/19/2020] [Accepted: 01/03/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) related diabetes (CFRD) is a common complication of CF. CFRD is associated with declining lung function even before its onset. Regular screening for CFRD using oral glucose tolerance test (OGTT) is recommended. Additionally, continuous glucose monitoring (CGM) has surfaced as a possible surveillance method, but evidence for its use and concordance with OGTT has not been established. METHODS Children were prospectively recruited at CF center Lund to undergo both intermittent scan CGM (isCGM) and OGTT. Lung function was evaluated by spirometry and multiple breath washout. Demographic and clinical data were collected from the Swedish national CF registry. RESULTS 32 patients participated in the study, yielding 28 pairs of isCGMs and OGTTs. The OGTTs showed that two patients met the criteria of CFRD, seven had impaired glucose tolerance (IGT) and indeterminate glycemia (INDET) was found in eleven cases. The isCGM percent of measurements >8mmol/L and the number of peaks per day >11 mmol/L have correlations with intermediate OGTT glucose time points, but not the 2hour glucose value. Patients with abnormal glucose tolerance (AGT) had lower lung function than those with normal glucose tolerance demonstrated by both FEV1% predicted and lung clearance index (LCI). CONCLUSION Correlations can be found between isCGM and OGTT in regards to the latter's intermediate time points. LCI demonstrates as well as FEV1% of predicted, worse lung function in children and adolescents with abnormal glucose tolerance in CF.
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Affiliation(s)
- H Elidottir
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden; Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden; Children´s Medical Center. Landspitali - The National University Hospital of Iceland.
| | - S Diemer
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden; Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden
| | - E Eklund
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden; Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden
| | - C R Hansen
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden; Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden
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21
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Nguyen CQT, Denis MH, Chagnon M, Rabasa-Lhoret R, Mailhot G. Abnormal glucose tolerance in a pediatric cystic fibrosis cohort: Trends in clinical outcomes and associated factors in the preceding years. Nutr Metab Cardiovasc Dis 2021; 31:277-285. [PMID: 32981797 DOI: 10.1016/j.numecd.2020.07.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS Deterioration of anthropometric and lung function parameters was shown to precede the onset of cystic fibrosis-related diabetes (CFRD) in adults. In children, studies have been conducted in small cohorts with relatively short observation period. Study objectives were to document the longitudinal trends of anthropometric, pulmonary, nutritional and metabolic parameters from cystic fibrosis (CF) diagnosis to the ascertainment of abnormal glucose tolerance and identify parameters associated with the incidence of such abnormalities in a pediatric CF cohort. METHODS AND RESULTS Retrospective cohort study of 281 children with CF. Longitudinal trends of anthropometric, lung function, nutritional and metabolic data were generated from CF diagnosis to the ascertainment of abnormal glucose tolerance defined as the presence of either impaired glucose tolerance (IGT), unconfirmed CFRD or CFRD. Cox models and Kaplan-Meier curves were used to identify factors associated with developing abnormal glucose tolerance. Forty-five percent of cohort had normal glucose tolerance (NGT), 27% IGT, 10% unconfirmed CFRD and 18% CFRD. Children who developed CFRD displayed lower height z-scores from a very early age. Conversely, HbA1c levels began to rise closer to CFRD ascertainment. Height z-scores (HR: 0.45; CI 95% [0.29-0.69]) and HbA1c (HR: 2.43; CI 95% [1.86-3.18]) in years preceding ascertainment were associated with the risk of developing CFRD. CONCLUSION Children who developed CFRD display distinctive trends for height z-scores from a very early age, whereas HbA1c appears as a marker of established glucose metabolism derangements.
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Affiliation(s)
- Cécile Q T Nguyen
- Research Centre, CHU Sainte-Justine, 3175 Cote Sainte-Catherine Rd, Montreal, Quebec H3T 1C5, Canada; Department of Nutrition, Faculty of Medicine, Université de Montreal, 2405 Cote Sainte-Catherine Rd, Montreal, Quebec H3T 1A8, Canada
| | - Marie-Hélène Denis
- Cystic Fibrosis Clinic, CHU Sainte-Justine, 3175 Cote Sainte-Catherine Rd, Montreal, Quebec H3T 1C5, Canada
| | - Miguel Chagnon
- Department of Mathematics and Statistics, Université de Montréal, 2920 Chemin de la tour, Montreal, Quebec H3T 1J4, Canada
| | - Rémi Rabasa-Lhoret
- Department of Nutrition, Faculty of Medicine, Université de Montreal, 2405 Cote Sainte-Catherine Rd, Montreal, Quebec H3T 1A8, Canada; Institut de Recherches Cliniques de Montréal (IRCM), 110 Pine Avenue, Montréal, Quebec H2W 1R7, Canada; Montreal Diabetes Research Center and Endocrine Division, Centre Hospitalier de l'Université de Montréal, 1051, Sanguinet Street, Montréal, Quebec H2X 3E4, Canada
| | - Geneviève Mailhot
- Research Centre, CHU Sainte-Justine, 3175 Cote Sainte-Catherine Rd, Montreal, Quebec H3T 1C5, Canada; Department of Nutrition, Faculty of Medicine, Université de Montreal, 2405 Cote Sainte-Catherine Rd, Montreal, Quebec H3T 1A8, Canada.
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22
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Gojsina B, Minic P, Todorovic S, Soldatovic I, Sovtic A. Continuous Glucose Monitoring as a Valuable Tool in the Early Detection of Diabetes Related to Cystic Fibrosis. Front Pediatr 2021; 9:659728. [PMID: 34307249 PMCID: PMC8298893 DOI: 10.3389/fped.2021.659728] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/09/2021] [Indexed: 01/13/2023] Open
Abstract
Aims: We evaluated the impact of cystic fibrosis-related diabetes (CFRD) on lung disease and nutritional status. Study Design: The retrospective cohort study evaluated the subjects' medical records from 2004 to 2019. All participants older than 10 years diagnosed by a 30-minutely sampled OGTT formed OGTT-CFRD subgroup. The participants diagnosed with continuous glucose monitoring (CGM) (at least two peaks above 11.1 mmol/l and more than 10% of recorded time above 7.8 mmol/l) formed a CFRD-CGM subgroup. The participants without CFRD formed a non-CFRD group. The longitudinal follow-up was made 2 years before and 3 years after insulin therapy initiation. Results: Of 144 participants included, aged 10-55 years (44% males), 28 (19.4%) had CFRD. The HbA1c was significantly lower in the CGM-CFRD in comparison to the OGTT-CFRD subgroup (5.9 ± 0.62 and 7.3 ± 1.7% respectfully; p = 0.04). Subjects with CFRD were malnourished in comparison to non-CFRD, with significant improvements with insulin replacement therapy in regard to BMI Z-score (-1.4 ± 1.3 vs. -0.5 ± 1.2%, p = 0.04) and pulmonary exacerbation score (p = 0.02). In OGTT-CFRD subgroup there is an increase in FEV1 (62.7 ± 26.3 to 65.1 ± 21.7%, p = 0.7) and decrease in FVC (from 76.4 ± 24.2 to 71.2 ± 20%, p = 0.003) from diagnosis to second year of follow-up. In CGM-CFRD subgroup there was a decrease in FEV1 (from 58.2 ± 28.2 to 52.8 ± 25.9%, p = 0.2) and FVC-values (from 72.4 ± 26.5 to 67.4 ± 29.1%, p = 0.08).Chronic Pseudomonas aeruginosa infection was more prevalent in the CFRD group (p = 0.003). Conclusion: Continuous glucose monitoring is a useful tool for insight of glucose impairment and diagnosis of CFRD. Early recognition of CFRD and therapeutic intervention has favorable effects on clinical course of the disease.
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Affiliation(s)
- Bojana Gojsina
- Department of Pulmonology, The Institute for Health Protection of Mother and Child Serbia, Belgrade, Serbia
| | - Predrag Minic
- Department of Pulmonology, The Institute for Health Protection of Mother and Child Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sladjana Todorovic
- Department of Endocrinology, The Institute for Health Protection of Mother and Child Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Sovtic
- Department of Pulmonology, The Institute for Health Protection of Mother and Child Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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23
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Mozzillo E, Franceschi R, Piona C, Passanisi S, Casertano A, Pjetraj D, Maltoni G, Calcaterra V, Cauvin V, Cherubini V, D’Annunzio G, Franzese A, Frongia AP, Lombardo F, Lo Presti D, Matteoli MC, Piccinno E, Predieri B, Rabbone I, Scaramuzza AE, Toni S, Zucchini S, Maffeis C, Schiaffini R. Diabetes and Prediabetes in Children With Cystic Fibrosis: A Systematic Review of the Literature and Recommendations of the Italian Society for Pediatric Endocrinology and Diabetes (ISPED). Front Endocrinol (Lausanne) 2021; 12:673539. [PMID: 34017312 PMCID: PMC8130616 DOI: 10.3389/fendo.2021.673539] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Cystic fibrosis related diabetes (CFRD) is a comorbidity of cystic fibrosis (CF) that negatively impacts on its clinical course. Prediabetes is an important predictor of either CFRD development and unfavorable prognosis of CF in both pediatric and adult patients. International guidelines recommend insulin only in case of CFRD diagnosis. Whether early detection and treatment of prediabetes may contribute to improve the clinical course of CF is still debated. A subgroup of pediatric diabetologists of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) performed a systematic review of the literature based on predefined outcomes: impact of pre-diabetes on clinical outcomes and on the risk of developing CFRD; diagnosis of diabetes and pre-diabetes under 10 years of age; effectiveness of therapy on glycemic control, impact of therapy on pulmonary function and nutritional status. Thirty-one papers were selected for the analysis data presented in these papers were reported in tables sorted by outcomes, including comprehensive evidence grading according to the GRADE approach. Following the grading of the quality of the evidence, the entire ISPED diabetes study group achieved consensus for the Italian recommendations based on both evidence and clinical experience. We concluded that in patients with CF, prediabetes should be carefully considered as it can evolve into CFRD. In patients with CF and prediabetic conditions, after complete evaluation of the OGTT trend, glucometrics, glycemic values measured during pulmonary exacerbations and/or steroid therapy, early initiation of insulin therapy could have beneficial effects on clinical outcomes of patients with CF and prediabetes.
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Affiliation(s)
- Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
| | - Roberto Franceschi
- Pediatric Unit, S. Chiara Hospital, Trento, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
| | - Claudia Piona
- Regional Center for Pediatric Diabetes, University of Verona, Verona, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Alberto Casertano
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Dorina Pjetraj
- SOD Pediatric Diabetology, Department of Women’s and Children’s, “G. Salesi” Children’s Hospital, AOU Ospedali Riuniti, Ancona, Italy
| | - Giulio Maltoni
- Department of Woman, Child and Urological Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Valeria Calcaterra
- University of Pavia, Pavia and Department of Pediatrics, "Vittore Buzzi" Children’s Hospital, Milano, Italy
| | | | - Valentino Cherubini
- SOD Pediatric Diabetology, Department of Women’s and Children’s, “G. Salesi” Children’s Hospital, AOU Ospedali Riuniti, Ancona, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | | | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Donatella Lo Presti
- Centro di Riferimento Regionale di Diabetologia Pediatrica A.O.U. Policlinico G. Rodolico, Catania, Italy
| | | | - Elvira Piccinno
- D.A.I. Pediatria, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults - Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy
| | | | - Sonia Toni
- Pediatric Diabetology Unit, Meyer Children Hospital, Florence, Italy
| | - Stefano Zucchini
- Department of Woman, Child and Urological Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University of Verona, Verona, Italy
| | - Riccardo Schiaffini
- Diabetes Unit, Bambino Gesù Children’s Hospital, Rome, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
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24
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Le TN, Anabtawi A, Putman MS, Tangpricha V, Stalvey MS. Growth failure and treatment in cystic fibrosis. J Cyst Fibros 2020; 18 Suppl 2:S82-S87. [PMID: 31679733 DOI: 10.1016/j.jcf.2019.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 01/10/2023]
Abstract
Poor growth has long been a characteristic feature of cystic fibrosis (CF) and is significantly linked to lung function and overall health status. Improvements in pulmonary and nutrition care for patients with cystic fibrosis (CF) have resulted in better growth outcomes; however, height gains have not paralleled the improvements in weight in children with CF, and patients with more severe CF mutations remain significantly more affected. Many factors affect the growth hormone-IGF-1 axis and the growth plate of the long bones, including the chronic inflammatory state associated with CF. There are also increasing data on the direct effects of CFTR on bone and implications for CFTR modulators in attaining optimal growth. Treatments aimed at improving growth in CF are also reviewed here.
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Affiliation(s)
- Trang N Le
- Departments of Internal Medicine and Pediatrics, Division of Endocrinology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Abeer Anabtawi
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Melissa S Putman
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Vin Tangpricha
- Atlanta VA Medical Center, Atlanta, GA, USA; Division of Endocrinology, Metabolism & Lipids, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael S Stalvey
- Atlanta VA Medical Center, Atlanta, GA, USA; Department of Pediatrics, University of Alabama at Birmingham, AL, USA
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25
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Nielsen BU, Kolpen M, Jensen PØ, Katzenstein T, Pressler T, Ritz C, Mathiesen IHM, Faurholt-Jepsen D. Neutrophil count in sputum is associated with increased sputum glucose and sputum L-lactate in cystic fibrosis. PLoS One 2020; 15:e0238524. [PMID: 32915806 PMCID: PMC7485830 DOI: 10.1371/journal.pone.0238524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Markers of lung inflammation measured directly in expectorated sputum have the potential of improving the timing of antibiotic treatment in cystic fibrosis (CF). L-Lactate might be a marker of inflammation, as it is produced from glucose by polymorphonuclear neutrophils (PMNs) in CF lungs. We aimed to investigate changes in and associations between PMNs, glucose and L-lactate in sputum during antibiotic treatment. In addition, the effect of hemoglobin A1c and plasma glucose on these biomarkers were investigated. METHODS We sampled non-induced sputum at day 0, 7, 14 and 42 in 27 chronically infected CF patients electively treated with 14 days of intravenous antibiotic. To analyze sputum samples, we used flowcytometry to count PMNs and colorimetric assays to estimate lactate and glucose. RESULTS No changes in levels of PMNs, glucose and lactate were detected in sputum during the antibiotic treatment. Sputum PMNs were positively associated with both glucose (log coefficient = 0.20, p = 0.01) and L-lactate (log coefficient = 0.34, p<0.001). In multivariate analyses, hemoglobin A1c was negatively associated with sputum PMNs (log coefficient = -1.68, p<0.001) and plasma glucose was negatively associated with sputum glucose (log coefficient = -0.09, p = 0.02). CONCLUSIONS In CF sputum PMNs, glucose and lactate were unchanged during elective antibiotic treatment. However, sputum PMNs were associated with both sputum glucose and sputum lactate. Surprisingly, hyperglycemia seemed to be associated with less PMNs infiltration and less glucose in CF sputum.
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Affiliation(s)
- Bibi Uhre Nielsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Mette Kolpen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Østrup Jensen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Costerton Biofilm Center, Institute of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Terese Katzenstein
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Tacjana Pressler
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Inger Hee Mabuza Mathiesen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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26
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Alves C, Della-Manna T, Albuquerque CTM. Cystic fibrosis-related diabetes: an update on pathophysiology, diagnosis, and treatment. J Pediatr Endocrinol Metab 2020; 33:835-843. [PMID: 32651985 DOI: 10.1515/jpem-2019-0484] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/10/2020] [Indexed: 12/16/2022]
Abstract
Cystic fibrosis (CF) is a highly prevalent autosomal recessive disorder that is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene (7q31.2), which encodes the CFTR chloride-anion channel that is expressed in several tissues. Life expectancy has increased significantly over the past few decades due to therapeutic advances and early diagnosis through neonatal screening. However, new complications have been identified, including CF-related diabetes (CFRD). The earliest detectable glycemic abnormality is postprandial hyperglycemia that progresses into fasting hyperglycemia. CFRD is associated with a decline in lung function, impairments in weight gain and growth, pubertal development, and increased morbidity and mortality. Annual screening with oral glucose tolerance test is recommended beginning at the age of 10, and screenings are recommended for any age group during the first 48 h of hospital admission. Fasting plasma glucose levels ≥126 mg/dL (7.0 mmol/L) or 2-h postprandial plasma glucose levels ≥200 mg/dL (11.1 mmol/L) that persist for more than 48 h are diagnostic criteria for CFRD. Under stable health condition, the diagnosis is made when laboratory abnormalities in accordance with the American Diabetes Association criteria are detected for the first time; however, levels of HbA1c <6.5% do not rule out the diagnosis. Treatment for CFRD includes insulin replacement and a hypercaloric and hyperproteic diet that does not restrict carbohydrates, fats or salt, and diabetes self-management education. The most important CFRD complications are nutritional and pulmonary disease deterioration, though the microvascular complications of diabetes have already been described.
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Affiliation(s)
- Crésio Alves
- Pediatric Endocrinology Unit, Hospital Universitario Prof. Edgard Santos, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Thais Della-Manna
- Pediatric Endocrinology Unit, Instituto da Criança, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (ICr-HC-FMUSP), São Paulo, Brazil
| | - Cristiano Tulio Maciel Albuquerque
- Pediatric Endocrinology, Hospital Infantil João Paulo II - Fundação Hospitalar do Estado de Minas Gerais (HIJPII/MG - FHEMIG), Belo Horizonte, Minas Gerais, Brazil
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27
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Affiliation(s)
- R E Warren
- Macleod Diabetes & Endocrine Centre, Royal Devon & Exeter Hospital, Exeter, UK
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28
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Iwanicki C, Logomarsino JV. Impaired glucose tolerance, body mass index and respiratory function in patients with cystic fibrosis: A systematic review. CLINICAL RESPIRATORY JOURNAL 2019; 13:341-354. [PMID: 30919537 DOI: 10.1111/crj.13019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/30/2018] [Accepted: 03/05/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This systematic review aims to evaluate body mass index (BMI) and forced expiratory volume in one second (FEV1 ) in patients with cystic fibrosis (CF) diagnosed with impaired glucose tolerance (IGT) compared to those with normal glucose tolerance (NGT). The significance of this topic stems from concern that individuals with CF and IGT may have an overall worse clinical status as indicated by BMI and FEV1 . DATA SOURCE An exhaustive literature search was completed between July 2017 and September 2017 using PubMed, CINAHL, Web of Science, Dissertations & Theses, PsycINFO, and Open Grey. Studies were limited to human subjects with CF. There were no restrictions on publication date, study design or language. STUDY SELECTION Included studies examined BMI and FEV1 as outcome measures in individuals with CF and IGT compared to those with NGT. After screening for inclusion criteria, 12 observational studies met the specified conditions. RESULTS Two studies showed a significantly worse BMI and FEV1 in subjects with CF and IGT compared to those with NGT. The remaining 10 studies found no significant associations with BMI and FEV1 in subjects with CF and IGT compared to NGT. CONCLUSION Although this review does not prove cause and effect, BMI and FEV1 are important outcome measures in patients with CF. Considering the inconclusive findings, practitioners should individualize care for this patient population. Additional research should focus on clinical status and interventions/treatment for individuals with CF and IGT.
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Affiliation(s)
- Courtney Iwanicki
- Division of Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
| | - John V Logomarsino
- Faculty, Nutrition & Dietetics, Department of Human Environmental Studies, Central Michigan University, The Villages, Florida
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29
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Colombo C, Alicandro G, Gambazza S, Mileto P, Mari A, Grespan E, Nazzari E, Russo MC, Battezzati A. Ventilation inhomogeneity is associated with OGTT-derived insulin secretory defects in cystic fibrosis. Pediatr Pulmonol 2019; 54:141-149. [PMID: 30575293 DOI: 10.1002/ppul.24212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/09/2018] [Indexed: 12/24/2022]
Abstract
Progressive deterioration of β-cell function is the main mechanism underlying diabetes in cystic fibrosis (CF). Diabetes negatively impacts the clinical status of CF patients years before its onset. We aimed to evaluate if OGTT-derived indices of β-cell function are associated with early markers of lung disease. We carried out a cross-sectional study on 80 CF patients who performed OGTT, spirometry, and nitrogen-multiple breath washout test. β-cell glucose sensitivity and the insulinogenic indices were used as markers of β-cell function and first-phase insulin response to glucose stimulus. We used sex- and age-adjusted multiple linear regression models to estimate the association between OGTT-derived indices and lung function measures. An increment of β-cell glucose sensitivity equal to its interquartile range was associated with an increase in ppFEV1 of 7.6 points (95%CI: 0.8; 14.4) as well as with a decrease in LCI of -1.96 units (95%CI: -3.40; -0.51) and in Scond of -0.016 L-1 (95%CI: -0.026; -0.007). The corresponding figures for insulinogenic index were: 8.6 (95%CI: 3.4; 13.9) for ppFEV1 , -2.03 (95%CI: -3.13; -0.94) for LCI, and -0.014 L-1 (95%CI: -0.021; -0.071) for Scond . When adjusting also for 2-h plasma glucose, both β-cell glucose sensitivity and insulinogenic index remained inversely associated with Scond . Deterioration of β-cell function is related to early lung disease in young patients with mild to normal pulmonary function. This relationship is independent from hyperglycemia and mainly involves conductive airways.
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Affiliation(s)
- Carla Colombo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Simone Gambazza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, U.O.C. Direzione delle Professioni Sanitarie, Milan, Italy
| | - Palmiro Mileto
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Andrea Mari
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Eleonora Grespan
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Erica Nazzari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Maria Chiara Russo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Alberto Battezzati
- Department of Food, Environmental and Nutritional Sciences, International Centre for the Assessment of Nutritional Status, University of Milan, Milan, Italy
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30
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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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31
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Terlizzi V, Lucarelli M, Salvatore D, Angioni A, Bisogno A, Braggion C, Buzzetti R, Carnovale V, Casciaro R, Castaldo G, Cirilli N, Collura M, Colombo C, Di Lullo AM, Elce A, Lucidi V, Madarena E, Padoan R, Quattrucci S, Raia V, Seia M, Termini L, Zarrilli F. Clinical expression of cystic fibrosis in a large cohort of Italian siblings. BMC Pulm Med 2018; 18:196. [PMID: 30577776 PMCID: PMC6303904 DOI: 10.1186/s12890-018-0766-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/12/2018] [Indexed: 02/10/2023] Open
Abstract
Background A clinical heterogeneity was reported in patients with Cystic Fibrosis (CF) with the same CFTR genotype and between siblings with CF. Methods We investigated all clinical aspects in a cohort of 101 pairs of siblings with CF (including 6 triplets) followed since diagnosis. Results Severe lung disease had a 22.2% concordance in sib-pairs, occurred early and the FEV1% at 12 years was predictive of the severity of lung disease in the adulthood. Similarly, CF liver disease occurred early (median: 15 years) and showed a concordance of 27.8% in sib-pairs suggesting a scarce contribution of genetic factors; in fact, only 2/15 patients with liver disease in discordant sib-pairs had a deficiency of alpha-1-antitrypsin (a known modifier gene of CF liver phenotype). CF related diabetes was found in 22 pairs (in 6 in both the siblings). It occurred later (median: 32.5 years) and is strongly associated with liver disease. Colonization by P. aeruginosa and nasal polyposis that required surgery had a concordance > 50% in sib-pairs and were poorly correlated to other clinical parameters. The pancreatic status was highly concordant in pairs of siblings (i.e., 95.1%) but a different pancreatic status was observed in patients with the same CFTR mutations. This suggests a close relationship of the pancreatic status with the “whole” CFTR genotype, including mutations in regulatory regions that may modulate the levels of CFTR expression. Finally, a severe course of CF was evident in a number of patients with pancreatic sufficiency. Conclusions Physicians involved in care of patients with CF and in genetic counseling must be aware of the clinical heterogeneity of CF even in sib-pairs that, at the state of the art, is difficult to explain. Electronic supplementary material The online version of this article (10.1186/s12890-018-0766-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vito Terlizzi
- Dipartimento di Pediatria, Centro Regionale Toscano per la Fibrosi Cistica, Azienda Ospedaliero-Universitaria Meyer, Viale Gaetano Pieraccini 24, 50139, Florence, Italy.
| | - Marco Lucarelli
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Istituto Pasteur Fondazione Cenci Bolognetti, Sapienza Università e Policlinico Umberto I, Rome, Italy
| | - Donatello Salvatore
- Centro Regionale Fibrosi Cistica, Centro Pediatrico Bambino Gesù Basilicata, AOR San Carlo, Potenza, Italy
| | - Adriano Angioni
- Laboratorio di Genetica Medica, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Arianna Bisogno
- Centro Regionale Fibrosi Cistica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Cesare Braggion
- Dipartimento di Pediatria, Centro Regionale Toscano per la Fibrosi Cistica, Azienda Ospedaliero-Universitaria Meyer, Viale Gaetano Pieraccini 24, 50139, Florence, Italy
| | | | - Vincenzo Carnovale
- Centro Regionale Fibrosi Cistica Adulti, Dipartimento di Scienze Mediche Traslazionali, Università di Napoli Federico II, Naples, Italy
| | - Rosaria Casciaro
- Centro Regionale Fibrosi Cistica, U.O.C. Pneumologia, IRCCS G. Gaslini, Genua, Italy
| | - Giuseppe Castaldo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy.,CEINGE-Biotecnologie avanzate, Naples, Italy
| | - Natalia Cirilli
- Centro Regionale Fibrosi Cistica, Dipartimento Materno-Infantile, Ospedali Riuniti Ancona, Ancona, Italy
| | - Mirella Collura
- CRR Fibrosi Cistica, Ospedale dei Bambini, ARNAS Civico, Palermo, Italy
| | - Carla Colombo
- Centro Regionale Fibrosi Cistica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Antonella Miriam Di Lullo
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologica, Università di Napoli Federico II, Naples, Italy
| | | | - Vincenzina Lucidi
- Unità Regionale di Fibrosi Cistica, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Elisa Madarena
- Centro Regionale Fibrosi Cistica, Ospedale Giovanni Paolo II, Lamezia, Italy
| | - Rita Padoan
- Centro Regionale di supporto Fibrosi Cistica, Dipartimento di Pediatria, Università di Brescia, AO Spedali Civili, Brescia, Italy
| | - Serena Quattrucci
- Centro Fibrosi Cistica Regione Lazio, Dipartimento di Pediatria e Neuropsichiatria Infantile, Sapienza Università-Policlinico Umberto I, Rome, Italy
| | - Valeria Raia
- Centro Regionale Fibrosi Cistica, Sezione Pediatrica, Dipartimento di Scienze Mediche Traslazionali, Università di Napoli Federico II, Naples, Italy
| | - Manuela Seia
- Laboratorio di Genetica Medica, Fondazione IRCCS Policlinico Ca' Granda Ospedale, Milan, Italy
| | - Lisa Termini
- Ospedale dei Bambini G. Di Cristina, Centro Regionale Fibrosi Cistica, Palermo, Italy
| | - Federica Zarrilli
- Dipartimento di Bioscienze e Territorio, Università del Molise, Isernia, Italy
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Regard L, Martin C, Chassagnon G, Burgel PR. Acute and chronic non-pulmonary complications in adults with cystic fibrosis. Expert Rev Respir Med 2018; 13:23-38. [PMID: 30472915 DOI: 10.1080/17476348.2019.1552832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF) is a genetic disease that primarily affects the respiratory system and often leads to respiratory failure and premature death. Although pulmonary complications contribute to 85% of deaths, non-pulmonary complications are responsible for significant morbidity and mortality in adults with CF. Areas covered: This review summarizes acute and chronic non-pulmonary complications in CF patients, with emphasis on emerging complications and in the context of the current growth and aging of the CF adult population. It also addresses the potential benefits of CF transmembrane conductance regulator modulator therapy. Complications that occur after solid organ (e.g. lung and/or liver) transplantation have been excluded. The review is based on an extensive search of the available literature, using PubMed and international guidelines, and on the authors' clinical experience. Expert commentary: Acute non-pulmonary complications have been well described but should be recognized and managed carefully. Managing chronic non-pulmonary complications is an important and changing aspect of CF patient care, particularly with the emergence of novel complications in adults. Early detection of non-pulmonary complications is essential to the development of prevention and treatment strategies that aim to further improve the survival and health status of adult CF patients.
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Affiliation(s)
- Lucile Regard
- a Faculté de Médecine , Paris Descartes University , Sorbonne Paris Cité , Paris , France.,b Pulmonology Department , Cochin Hospital, AP-HP , Paris , France
| | - Clémence Martin
- a Faculté de Médecine , Paris Descartes University , Sorbonne Paris Cité , Paris , France.,b Pulmonology Department , Cochin Hospital, AP-HP , Paris , France
| | - Guillaume Chassagnon
- a Faculté de Médecine , Paris Descartes University , Sorbonne Paris Cité , Paris , France.,c Radiology Department , Cochin Hospital, AP-HP , Paris , France
| | - Pierre-Régis Burgel
- a Faculté de Médecine , Paris Descartes University , Sorbonne Paris Cité , Paris , France.,b Pulmonology Department , Cochin Hospital, AP-HP , Paris , France
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Bechtold SM, Rohrer TR, Raile K, Hofer S, Thon A, Boettcher C, Konrad K, Pozza RD, Bollow E, Holl RW. Diabetes mellitus in pediatric solid organ recipients without and with cystic fibrosis: An analysis from the German-Austrian diabetes database (Diabetes Patienten Verlaufsdokumentation). Pediatr Diabetes 2018; 19:1191-1197. [PMID: 30070005 DOI: 10.1111/pedi.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/17/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Posttransplantation diabetes mellitus (PTDM) increases the risk of cardiovascular disease, graft loss, and decreased survival. Follow-up treatment after solid organ transplantation (SOT) needs to focus on, inter alia, maintaining balanced glucose metabolism. This study aimed to ascertain the prevalence of PTDM and describe patient characteristics in the large DPV (Diabetes Patienten Verlaufsdokumentation) pediatric diabetes database. METHODS DPV data of 71 902 patients from the January 01, 1995 to January 04, 2015 period were analyzed for patients with and without cystic fibrosis (CF) after SOT (kidney, liver, heart, and lung). Multivariable analysis served to assess differences between SOT patient groups at risk for developing diabetes. RESULTS Out of 109 SOT patients, 51 had CF; 72.5% received steroids and 62% were additionally given tacrolimus. PTDM developed in 45% of CF patients and 12% of non-CF patients. SOT patients were older at diabetes onset (mean age, 12.50 ± 3.98 years), shorter (height z-score, -1.67 ± 1.25), and lighter (weight z-score, -1.59 ± 1.57) than non-SOT diabetes patients (P < 0.01). With transplantation, glycated hemoglobin (HbA1c) was significantly lower and treatment for hypertension and dyslipidemia was increased. Among SOT patients, weight and body mass index (BMI) z-scores were significantly lower in patients with CF-related diabetes (P < 0.05). CONCLUSIONS SOT was present in 6.6% of children with diabetes, and this might aggravate the risk of cardiovascular disease in populations with already increased rates of hypertension and dyslipidemia. Dystrophy and short stature were also present, particularly in transplant recipients with CF and diabetes. Comorbidities and long-term consequences call for multidisciplinary collaboration.
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Affiliation(s)
- Susanne M Bechtold
- Department of Pediatric Endocrinology and Diabetology, Ludwig-Maximilian's University Medicine Munich, Munich, Germany
| | - Tilman R Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetology, Charité University Medicine Berlin, Berlin, Germany
| | - Sabine Hofer
- Department of Pediatrics, University Hospital Innsbruck, Innsbruck, Austria
| | - Angelika Thon
- Department of Pediatrics, Hannover Medical University, Hannover, Germany
| | - Claudia Boettcher
- Division of Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Gießen, Germany
| | - Katja Konrad
- Department of Pediatrics, Elisabeth Krankenhaus Essen, Essen, Germany.,Medical University of Cologne, Köln, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology, Ludwig-Maximilian's University Medicine Munich, Munich, Germany
| | - Esther Bollow
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Rotti PG, Xie W, Poudel A, Yi Y, Sun X, Tyler SR, Uc A, Norris AW, Hara M, Engelhardt JF, Gibson-Corley KN. Pancreatic and Islet Remodeling in Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Knockout Ferrets. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:876-890. [PMID: 29366680 DOI: 10.1016/j.ajpath.2017.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/05/2017] [Accepted: 12/28/2017] [Indexed: 12/25/2022]
Abstract
In cystic fibrosis (CF), there is early destruction of the exocrine pancreas, and this results in a unique form of diabetes that affects approximately half of adult CF individuals. An animal model of cystic fibrosis-related diabetes has been developed in the ferret, which progresses through phases of glycemic abnormalities because of islet remodeling during and after exocrine destruction. Herein, we quantified the pancreatic histopathological changes that occur during these phases. There was an increase in percentage ductal, fat, and islet area in CF ferrets over time compared with age-matched wild-type controls. We also quantified islet size, shape, islet cell composition, cell proliferation (Ki-67), and expression of remodeling markers (matrix metalloprotease-7, desmin, and α-smooth muscle actin). Pancreatic ducts were dilated with scattered proliferating cells and were surrounded by activated stellate cells, indicative of tissue remodeling. The timing of islet and duct proliferation, stellate cell activation, and matrix remodeling coincided with the previously published stages of glycemic crisis and inflammation. This mapping of remodeling events in the CF ferret pancreas provides insights into early changes that control glycemic intolerance and subsequent recovery during the evolution of CF pancreatic disease.
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Affiliation(s)
- Pavana G Rotti
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa; Department of Biomedical Engineering, The University of Iowa, Iowa City, Iowa
| | - Weiliang Xie
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa
| | - Ananta Poudel
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Yaling Yi
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa
| | - Xingshen Sun
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa
| | - Scott R Tyler
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa
| | - Aliye Uc
- Stead Family Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Andrew W Norris
- Stead Family Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Manami Hara
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - John F Engelhardt
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa
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Lecube A, Simó R, Pallayova M, Punjabi NM, López-Cano C, Turino C, Hernández C, Barbé F. Pulmonary Function and Sleep Breathing: Two New Targets for Type 2 Diabetes Care. Endocr Rev 2017; 38:550-573. [PMID: 28938479 DOI: 10.1210/er.2017-00173] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
Population-based studies showing the negative impact of type 2 diabetes (T2D) on lung function are overviewed. Among the well-recognized pathophysiological mechanisms, the metabolic pathways related to insulin resistance (IR), low-grade chronic inflammation, leptin resistance, microvascular damage, and autonomic neuropathy are emphasized. Histopathological changes are exposed, and findings reported from experimental models are clearly differentiated from those described in humans. The accelerated decline in pulmonary function that appears in patients with cystic fibrosis (CF) with related abnormalities of glucose tolerance and diabetes is considered as an example to further investigate the relationship between T2D and the lung. Furthermore, a possible causal link between antihyperglycemic therapies and pulmonary function is examined. T2D similarly affects breathing during sleep, becoming an independent risk factor for higher rates of sleep apnea, leading to nocturnal hypoxemia and daytime sleepiness. Therefore, the impact of T2D on sleep breathing and its influence on sleep architecture is analyzed. Finally, the effect of improving some pathophysiological mechanisms, primarily IR and inflammation, as well as the optimization of blood glucose control on sleep breathing is evaluated. In summary, the lung should be considered by those providing care for people with diabetes and raise the central issue of whether the normalization of glucose levels can improve pulmonary function and ameliorate sleep-disordered breathing. Therefore, patients with T2D should be considered a vulnerable group for pulmonary dysfunction. However, further research aimed at elucidating how to screen for the lung impairment in the population with diabetes in a cost-effective manner is needed.
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Affiliation(s)
- Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Rafael Simó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Maria Pallayova
- Department of Medicine, Weill Cornell Medicine.,Department of Human Physiology and Sleep Laboratory, Faculty of Medicine, Pavol Jozef Šafárik University, Slovak Republic
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cecilia Turino
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cristina Hernández
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Ferran Barbé
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain
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