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Wu Y, Que Y, Chen J, Sun L, Guo J, Ruan YC. CFTR Modulates Hypothalamic Neuron Excitability to Maintain Female Cycle. Int J Mol Sci 2023; 24:12572. [PMID: 37628754 PMCID: PMC10454438 DOI: 10.3390/ijms241612572] [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: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Cystic fibrosis transmembrane conductance regulator (CFTR), known as an epithelial Cl- channel, is increasingly noted to be expressed in the nervous system, although whether and how it plays a role in neuronal excitability is unclear. Given the association of CFTR with fertility, we tested here possible involvement of CFTR in regulating hypothalamic neuron excitability. Patch-clamp and Ca2+ imaging showed that pharmacological inhibition of CFTR evoked electrical pulses and Ca2+ spikes in primary rat hypothalamic neurons, which was dependent on extracellular Cl-. Hypothalamic neurons in brain-slice preparations from adult female mice with CFTR mutation (DF508) exhibited significantly reduced electrical pulses as compared to the wild-type controls. Removal of extracellular Cl- eliminated hypothalamic electrical pulses in the wild-type brain slices, which was reversible by subsequent addition of Cl-. In adult female mice, Ca2+ indicator (GCaMP6s)-based fiber-photometry showed that hypothalamic Ca2+ activities in vivo were enhanced at the proestrus/estrus phase as compared to the diestrus phase of the female cycle. Such estrus-associated hypothalamic activities were largely diminished in DF508 female mice, together with delayed puberty and disturbed female cycles. Therefore, these findings suggest a critical role of CFTR in modulating hypothalamic neuron excitability, which may account for the disturbed female cycles and reduced female fertility associated with CFTR mutations.
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Affiliation(s)
- Yong Wu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China (J.G.)
- Department of Physiology, Jinan University, Guangzhou 510632, China
| | - Yanting Que
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China (J.G.)
| | - Junjiang Chen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China (J.G.)
- Department of Physiology, Jinan University, Guangzhou 510632, China
| | - Lei Sun
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China (J.G.)
| | - Jinghui Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China (J.G.)
- Department of Physiology, Jinan University, Guangzhou 510632, China
- School of Medicine, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Ye Chun Ruan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China (J.G.)
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Gu J, Zhang W, Wu L, Gu Y. CFTR Deficiency Affects Glucose Homeostasis via Regulating GLUT4 Plasma Membrane Transportation. Front Cell Dev Biol 2021; 9:630654. [PMID: 33659254 PMCID: PMC7917208 DOI: 10.3389/fcell.2021.630654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/27/2021] [Indexed: 12/02/2022] Open
Abstract
Cystic Fibrosis (CF) is an autosomal recessive disorder caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. CF-related diabetes (CFRD) is one of the most prevalent comorbidities of CF. Altered glucose homeostasis has been reported in CF patients. The mechanism has not been fully elucidated. Besides the consequence of pancreatic endocrine dysfunction, we focus on insulin-responsive tissues and glucose transportation to explain glucose homeostasis alteration in CFRD. Herein, we found that CFTR knockout mice exhibited insulin resistance and glucose tolerance. Furthermore, we demonstrated insulin-induced glucose transporter 4 (GLUT4) translocation to the cell membrane was abnormal in the CFTR knockout mice muscle fibers, suggesting that defective intracellular GLUT4 transportation may be the cause of impaired insulin responses and glucose homeostasis. We further demonstrated that PI(4,5)P2 could rescue CFTR related defective intracellular GLUT4 transportation, and CFTR could regulate PI(4,5)P2 cellular level through PIP5KA, suggesting PI(4,5)P2 is a down-stream signal of CFTR. Our results revealed a new signal mechanism of CFTR in GLUT4 translocation regulation, which helps explain glucose homeostasis alteration in CF patients.
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Affiliation(s)
- Junzhong Gu
- Molecular Pharmacology Laboratory, Institute of Molecular Medicine, Peking University, Beijing, China
| | - Weiwei Zhang
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Lida Wu
- Molecular Pharmacology Laboratory, Institute of Molecular Medicine, Peking University, Beijing, China
| | - Yuchun Gu
- Molecular Pharmacology Laboratory, Institute of Molecular Medicine, Peking University, Beijing, China.,Translational and Regenerative Medicine Centre, Aston Medical School, Aston University, Birmingham, United Kingdom
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Calliari LE, Almeida FJ, Noronha RM. Infections in children with diabetes. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Calliari LE, Almeida FJ, Noronha RM. Infections in children with diabetes. J Pediatr (Rio J) 2020; 96 Suppl 1:39-46. [PMID: 31666181 PMCID: PMC9432288 DOI: 10.1016/j.jped.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The association between diabetes mellitus and infections is very common. These infections, even when mild, interfere with blood glucose control. The aim of this review is to describe infections that occur in children and adolescents with DM, as well as to provide recommendations on glycemia management during these episodes. SOURCE OF DATA A non-systematic review was carried out in the PubMed database, using the terms "diabetes mellitus," "infection," "children," and "adolescents." The most relevant publications were selected. SYNTHESIS OF DATA In addition to the usual community diseases, some infections may occur predominantly in diabetic patients, especially when there is inadequate glycemic control, and common infections can be more severe in these patients. Alterations caused by the disease itself and the immune response are responsible for the risk of higher frequency and severity of infections. During infections, an increase in blood glucose occurs and usually an increase in insulin dose is required. CONCLUSIONS Pediatric patients with diabetes have some immune system disorders that, when associated with high glycemia, increase the risk of infections and their severity, and should be promptly identified and treated. The presence of an infectious condition, in turn, raises blood glucose and increases the risk of decompensation, and pediatricians should be cautioned to intensify monitoring and insulin therapy, and to avoid the risk of DKA. It should also be noted that many infections are preventable and can be avoided with adequate vaccine coverage.
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Affiliation(s)
- Luis Eduardo Calliari
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Unidade de Endocrinologia Pediátrica e Ambulatório de Diabetes Pediátrico, São Paulo, SP, Brasil.
| | - Flávia J Almeida
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Unidade de Infectologia Pediátrica, São Paulo, SP, Brasil
| | - Renata Maria Noronha
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Ambulatório de Diabetes Pediátrico, São Paulo, SP, Brasil
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Marunaka Y. The Mechanistic Links between Insulin and Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Cl - Channel. Int J Mol Sci 2017; 18:ijms18081767. [PMID: 28805732 PMCID: PMC5578156 DOI: 10.3390/ijms18081767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/31/2017] [Accepted: 08/10/2017] [Indexed: 12/30/2022] Open
Abstract
The cystic fibrosis transmembrane conductance regulator (CFTR) Cl− channel belongs to the ATP-binding cassette (ABC) transporter superfamily and regulates Cl− secretion in epithelial cells for water secretion. Loss-of-function mutations to the CFTR gene cause dehydrated mucus on the apical side of epithelial cells and increase the susceptibility of bacterial infection, especially in the airway and pulmonary tissues. Therefore, research on the molecular properties of CFTR, such as its gating mechanism and subcellular trafficking, have been intensively pursued. Dysregulated CFTR trafficking is one of the major pathological hallmarks in cystic fibrosis (CF) patients bearing missense mutations in the CFTR gene. Hormones that activate cAMP signaling, such as catecholamine, have been found to regulate the intracellular trafficking of CFTR. Insulin is one of the hormones that regulate cAMP production and promote trafficking of transmembrane proteins to the plasma membrane. The functional interactions between insulin and CFTR have not yet been clearly defined. In this review article, I review the roles of CFTR in epithelial cells, its regulatory role in insulin secretion, and a mechanism of CFTR regulation by insulin.
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Affiliation(s)
- Yoshinori Marunaka
- Department of Molecular Cell Physiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
- Department of Bio-Ionomics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
- Japan Institute for Food Education and Health, St. Agnes' University, Kyoto 602-8013, Japan.
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Bilodeau C, Bardou O, Maillé É, Berthiaume Y, Brochiero E. Deleterious impact of hyperglycemia on cystic fibrosis airway ion transport and epithelial repair. J Cyst Fibros 2016; 15:43-51. [DOI: 10.1016/j.jcf.2015.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 02/08/2023]
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Franzese A, Mozzillo E, Fattorusso V, Raia V, Valerio G. Screening of glucose metabolism derangements in pediatric cystic fibrosis patients: how, when, why. Acta Diabetol 2015; 52:633-8. [PMID: 25863781 DOI: 10.1007/s00592-015-0743-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
Diabetes mellitus is the most common comorbidity in cystic fibrosis (CF), occurring in a variable number of children and adolescents. Glucose metabolism derangements (GMDs) are responsible for a negative impact on the general health status of CF patients. Screening of GMDs is important since the youngest age and should be performed by means of OGTT, including its intermediate times, that could detect other non-traditional GMDs. Insulin treatment, administered before overt diabetes, could be beneficial in reducing the number of pulmonary infections, in improving both pulmonary function and nutritional status. Early screening of GMDs in pediatric age can exert an important preventing role regarding all aspects of health status of patients with CF.
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Affiliation(s)
- Adriana Franzese
- Department of Medical and Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy,
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Siwamogsatham O, Alvarez J, Tangpricha V. Diagnosis and treatment of endocrine comorbidities in patients with cystic fibrosis. Curr Opin Endocrinol Diabetes Obes 2014; 21:422-9. [PMID: 25105995 PMCID: PMC4326081 DOI: 10.1097/med.0000000000000096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an update on various relevant endocrine aspects of care in adolescents and adults with cystic fibrosis. RECENT FINDINGS As life expectancy in cystic fibrosis has continuously improved, endocrine complications have become more apparent. The common endocrine complications include cystic fibrosis related diabetes, cystic fibrosis related bone disease, vitamin D deficiency and poor growth and pubertal development. Thyroid and adrenal disorders have also been reported, although the prevalence appears to be less common. SUMMARY Endocrine diseases are an increasingly recognized complication that has a significant impact on the overall health of individuals with cystic fibrosis. This review summarizes the updated screening and management of endocrine diseases in the cystic fibrosis population.
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Affiliation(s)
- Oranan Siwamogsatham
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Samitivej Srinakarin Hospital, Bangkok Hospital Group, Bangkok, Thailand,
| | - Jessica Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA,
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Emory Adult Cystic Fibrosis Program, Emory Healthcare, Atlanta, GA
- Section of Endocrinology, Atlanta VA Medical Center, Decatur, GA, 101 Woodruff Circle NE- WMRB1301, Atlanta, GA 30322, Phone (404) 727-7254, Fax (404) 592-6257,
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Guo JH, Chen H, Ruan YC, Zhang XL, Zhang XH, Fok KL, Tsang LL, Yu MK, Huang WQ, Sun X, Chung YW, Jiang X, Sohma Y, Chan HC. Glucose-induced electrical activities and insulin secretion in pancreatic islet β-cells are modulated by CFTR. Nat Commun 2014; 5:4420. [PMID: 25025956 PMCID: PMC4104438 DOI: 10.1038/ncomms5420] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/17/2014] [Indexed: 01/08/2023] Open
Abstract
The cause of insulin insufficiency remains unknown in many diabetic cases. Up to 50% adult patients with cystic fibrosis (CF), a disease caused by mutations in the gene encoding the CF transmembrane conductance regulator (CFTR), develop CF-related diabetes (CFRD) with most patients exhibiting insulin insufficiency. Here we show that CFTR is a regulator of glucose-dependent electrical acitivities and insulin secretion in β-cells. We demonstrate that glucose elicited whole-cell currents, membrane depolarization, electrical bursts or action potentials, Ca(2+) oscillations and insulin secretion are abolished or reduced by inhibitors or knockdown of CFTR in primary mouse β-cells or RINm5F β-cell line, or significantly attenuated in CFTR mutant (DF508) mice compared with wild-type mice. VX-809, a newly discovered corrector of DF508 mutation, successfully rescues the defects in DF508 β-cells. Our results reveal a role of CFTR in glucose-induced electrical activities and insulin secretion in β-cells, shed light on the pathogenesis of CFRD and possibly other idiopathic diabetes, and present a potential treatment strategy.
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Affiliation(s)
- Jing Hui Guo
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Hui Chen
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ye Chun Ruan
- 1] Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China [2] Sichuan University-The Chinese University of Hong Kong Joint Laboratory for Reproductive Medicine, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education of China, West China Second University Hospital, Sichuan University, Chengdu 610041, China [3] Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Xue Lian Zhang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xiao Hu Zhang
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Kin Lam Fok
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai Ling Tsang
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Mei Kuen Yu
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wen Qing Huang
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiao Sun
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yiu Wa Chung
- Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiaohua Jiang
- 1] Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China [2] Sichuan University-The Chinese University of Hong Kong Joint Laboratory for Reproductive Medicine, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education of China, West China Second University Hospital, Sichuan University, Chengdu 610041, China [3] Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yoshiro Sohma
- Department of Pharmacology, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Hsiao Chang Chan
- 1] Epithelial Cell Biology Research Center, Key Laboratory of Regenerative Medicine of Ministry of Education of China, CUHK-SJTU Joint Center for Human Reproduction and Related Disease, Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China [2] Sichuan University-The Chinese University of Hong Kong Joint Laboratory for Reproductive Medicine, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education of China, West China Second University Hospital, Sichuan University, Chengdu 610041, China [3] Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Noronha RM, Damaceno N, Muramatu LH, Monte O, Calliari LEP. Importance of screening with oral glucose tolerance test for early diagnosis of cystic fibrosis-related diabetes mellitus. Pediatr Diabetes 2014; 15:309-12. [PMID: 24256553 DOI: 10.1111/pedi.12094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 09/24/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To evaluate (a) the prevalence of cystic fibrosis-related diabetes mellitus (CFRD) in a non-Caucasian population treated in a University Hospital in São Paulo, Brazil; and (b) if annual screening of patients with cystic fibrosis (CF) ≥ 10 yr of age, with oral glucose tolerance test (OGTT), resulted in early detection of CFRD. SUBJECTS AND METHODS A cross-sectional study was performed with retrospective/prospective analysis of CF patients ≥10 yr of age. Various parameters were analyzed. Patients previously diagnosed with CFRD had their parameters collected at the time of diabetes diagnosis; others were submitted to annual OGTTs, with the parameters collected at the time of their last OGTT. RESULTS A total of 60 subjects [29 females/31 males; mean age 19.1 yr (±7.6)] were analyzed. In our group of CF patients, we found that 30% had CFRD, 26.7% had altered response to OGTT, and 43.3% had normal glucose tolerance. Analysis of those patients with CFRD showed that the mean age at the time of diagnosis of CFRD, in patients diagnosed by OGTT screening, was 13.5 yr (±2.9) vs. 22.3 yr (±5.4) among those previously diagnosed by clinical suspicion (p < 0.001). CONCLUSIONS The prevalence of CFRD in our patients is high, similar to the data from Caucasian populations, and significantly higher than previously reported in Brazil. Screening with OGTT resulted in earlier diagnosis of CFRD by 8 yr. These data may help convince national CF centers that CFRD is frequent, and that screening should be mandatory.
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Affiliation(s)
- Renata Maria Noronha
- Division of Pediatric Endocrinology, Department of Pediatrics, Santa Casa School of Medicine, São Paulo, SP, Brazil
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Rasouli N, Seggelke S, Gibbs J, Hawkins RM, Casciano ML, Cohlmia E, Taylor-Cousar J, Wang C, Pereira R, Hsia E, Draznin B. Cystic fibrosis-related diabetes in adults: inpatient management of 121 patients during 410 admissions. J Diabetes Sci Technol 2012; 6:1038-44. [PMID: 23063029 PMCID: PMC3570837 DOI: 10.1177/193229681200600507] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND With improved longevity, cystic fibrosis (CF)-related diabetes (CFRD) has emerged as the most common nonpulmonary complication of CF. Patients with CFRD are frequently admitted to the hospital with infections and deterioration of pulmonary function, during which time glycemic control might have an impact on pulmonary function, recovery from infection, and survival. METHODS AND RESULTS In an attempt to share our insight into inpatient management of CFRD, this article summarizes the experience of our inpatient glucose management team with hospital management of 121 adult CFRD patients who were hospitalized on 410 occasions at the University of Colorado Hospital between January 2009 and September 2011. This is a retrospective chart review descriptive study of inpatient management of CFRD in our center. Our cohort includes CFRD patients treated with basal and mealtime insulin through multiple daily injections or continuous subcutaneous insulin infusion (CSII), as well as patients receiving steroids or enteral nutrition, which adds complexity to the management of CFRD during hospitalization. CONCLUSIONS Multiple hospitalizations and intensive inpatient management of CF are integral elements of treatment. Inpatient therapy for CFRD requires a customized approach that is uniquely different from that of type 1 or type 2 diabetes. Our experience highlights clinical circumstances such as irregular food intake, high dose steroid therapy, and supplemental tube feeding. For many patients, it is possible to continue CSII therapy during hospitalization through a combination of mutual trust between the patient and hospital staff and oversight provided by the glucose management team.
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Affiliation(s)
- Neda Rasouli
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
- Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Stacey Seggelke
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Joanna Gibbs
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - R. Matthew Hawkins
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | | | - Elizabeth Cohlmia
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Jennifer Taylor-Cousar
- Pulmonary Division, Department of Medicine and Pediatrics, National Jewish Health, Denver, Colorado
- Pulmonary Division, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Cecilia Wang
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
- Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Rocio Pereira
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Elisa Hsia
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Boris Draznin
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
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