1
|
Saegebrecht LS, Röhlig M, Schaub F, Ballmann M, Stachs O, Fischer DC. Glycemic Variability and the Thickness of Retinal Layers in Cystic Fibrosis Patients with and without Cystic Fibrosis Related Diabetes. Curr Eye Res 2024:1-9. [PMID: 38557392 DOI: 10.1080/02713683.2024.2333770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Patients with cystic fibrosis (CF) are at risk to develop CF related diabetes (CFRD) and subsequently even diabetic neuro- and/or vasculopathy. We sought to determine if there are typical signs of diabetes-related retinal alterations present in CF patients with preserved and impaired glycemic control. METHODS During routine annual examination CF patients were offered an additional 7-day period of real time continuous glucose monitoring (rtCGM) and an ophthalmological examination including retinal optical coherence tomography (OCT). Patients were categorized according to the glycemic control, i.e. the results of an oral glucose tolerance test (OGTT) and rtCGM were taken into consideration. OCT data was analyzed by our previously published visual analysis software generating dedicated and spatially resolved deviation maps for visualization and quantification of differences in total retinal thickness and thickness of retinal nerve fiber layer (RNFL) as well as ganglion cell layer (GCL) in comparison to age-matched healthy controls and patients with either type 1 or type 2 diabetes mellitus. RESULTS Results of the rtCGM and/or OGTT enabled discrimination between patients with normal glycemic control (CFNG; n = 6), with abnormal glycemic control (CFAG; n = 6) and overt CFRD (n = 4). OCT data indicates gradually increasing retinal thinning in all 3 groups, depending on the degree of glucose metabolism disorder compared to healthy controls. At the foveal region total retinal thickness and GCL thickness were significantly thinner in CFRD patients compared to CFNG patients (total retinal thickness: 260.4 µm (239.3-270.8) vs. 275.4 µm (254.3-289.5); GCL: 11.82 µm (11.16-15.25) vs. 17.30 µm (13.95-19.82); each p < 0.05). CONCLUSION Although we investigated a rather small number of patients, we obtained evidence that intraretinal neurodegenerative changes occur in each of our subgroups (CFNG, CFAG, CFRD). Beyond this, our results favor the detrimental role of additional diabetes, as the deviations from healthy controls were most pronounced in the CFRD group and are similar to those seen in patients suffering from type 1 or type 2 diabetes.
Collapse
Affiliation(s)
- Luisa S Saegebrecht
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Martin Röhlig
- Institute of Visual and Analytic Computing, University of Rostock, Rostock, Germany
| | - Friederike Schaub
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Manfred Ballmann
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| |
Collapse
|
2
|
Taelman V, Declercq D, Van Biervliet S, Weygaerde YV, Lapauw B, Van Braeckel E. Effect of 18 months elexacaftor-tezacaftor-ivacaftor on body mass index and glycemic control in adults with cystic fibrosis. Clin Nutr ESPEN 2023; 58:73-78. [PMID: 38057039 DOI: 10.1016/j.clnesp.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND & AIMS Malnutrition and cystic fibrosis related diabetes (CFRD) are common comorbidities in cystic fibrosis (CF). Cystic fibrosis transmembrane regulator (CFTR) modulators have shown beneficial effects on respiratory status. This study aims to determine the effect of elexacaftor-tezacaftor-ivacaftor (ETI) on body mass index (BMI) and glycemic control. METHODS A retrospective, observational study of a cohort of 17 adult CF patients was conducted at the CF reference center of Ghent University Hospital. BMI evolution was analyzed 18 months before and 0, 3, 6, 12 and 18 months after the start of ETI. The evolution of insulin dependence and the 2 h oral glucose tolerance test (OGTT) results were described until 36 months after start of ETI, in a small subgroup of ten patients with CFRD or impaired glucose tolerance (IGT). RESULTS A significant increase in mean BMI of 1.2 kg/m2 (±1.3 SD) was observed. Most weight gain was observed in the first 3 months after starting treatment. This effect was sustained during the observed period of 18 months. Six patients had insulin dependent CFRD, of which three were able to stop insulin after starting ETI. Two patients with CFRD treated with dietary measures showed an initial normalization of the 2 h OGTT, but deterioration at 36 month follow-up. CONCLUSIONS After initiation of ETI an increase in BMI was observed in adults with CF. ETI can have a beneficial impact on glucose metabolism in patients with CFRD, leading to a possible need for reduction or cessation of insulin therapy.
Collapse
Affiliation(s)
- Valerie Taelman
- Department of Endocrinology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Dimitri Declercq
- Cystic Fibrosis Reference Centre, Ghent University Hospital, C. Heymanslaan 10, 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, C. Heymanslaan 10, Ghent, Belgium
| | - Stephanie Van Biervliet
- Cystic Fibrosis Reference Centre, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Paediatrics, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent, Belgium
| | - Yannick Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent, Belgium
| | - Eva Van Braeckel
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent, Belgium; Department of Respiratory Medicine, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium
| |
Collapse
|
3
|
Steinack C, Ernst M, Beuschlein F, Hage R, Roeder M, Schuurmans MM, Schmid C, Gaisl T. Improved glucose tolerance after initiation of Elexacaftor / Tezacaftor / Ivacaftor in adults with cystic fibrosis. J Cyst Fibros 2023; 22:722-729. [PMID: 36669960 DOI: 10.1016/j.jcf.2023.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND The novel triple CFTR modulator therapy Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) improves lung function, body mass index (BMI), sinus clearance, and quality of life in patients with cystic fibrosis. Whether treatment with ELX/TEZ/IVA is associated with improved glucose tolerance is unknown. METHODS This cohort study included adults with CF and at least one copy of F508del.. Study assessments before treatment and at least 3 months after ELX/TEZ/IVA initiation included an oral glucose tolerance test (OGTT) with glucose and insulin measurements, BMI, lung function test, and sweat chloride levels. We used an analysis of response profiles to calculate changes in outcomes. RESULTS 33 patients (27.8 ± 6.3 years; 73% male; 64% F508del homozygous) were included. After a median of 184 [IQR, 107 - 278] days following treatment initiation 16 (48.5%) patients improved their glucose tolerance category, while 13 (39.4%) remained unchanged and 4 (12.1%) deteriorated. Overall, 60, 90 and 120 min OGTT glycemia decreased significantly from 11.9 ± 2.7 mmol/l to 10.6 ± 2.8 mmol/l (p = 0.012), 10.4 ± 3.0 mmol/l to 8.4 ± 3.6 mmol/l (p = 0.002) and 7.3 ± 3.1 mmol/l to 5.7 ± 3.0 mmol/l (p = 0.012). HbA1c levels also improved significantly, from 5.50±0.24% to 5.39±0.25% (p = 0.039). CONCLUSION In adult patients with CF and at least one copy of F508del, treatment with the triple CFTR modulator was associated with possible improvement of glucose tolerance without increases of insulin secretion. Early initiation of treatment as assessed through long-term prospective trials is mandatory to demonstrate if decreased glucose control is preventable or even reversible.
Collapse
Affiliation(s)
- Carolin Steinack
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland.
| | - Matthias Ernst
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | - René Hage
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Schmid
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
Radtke T, Kriemler S, Stein L, Karila C, Urquhart DS, Orenstein DM, Lands LC, Schindler C, Eber E, Haile SR, Hebestreit H. Cystic fibrosis related diabetes is not associated with maximal aerobic exercise capacity in cystic fibrosis: a cross-sectional analysis of an international multicenter trial. J Cyst Fibros 2023; 22:31-38. [PMID: 35803884 DOI: 10.1016/j.jcf.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have reported differences in aerobic exercise capacity, expressed as peak oxygen uptake (VO2peak), between people with and without cystic fibrosis (CF) related diabetes (CFRD). However, none of the studies controlled for the potential influence of physical activity on VO2peak. We investigated associations between CFRD and VO2peak following rigorous control for confounders including objectively measured physical activity. METHODS Baseline data from the international multicenter trial ACTIVATE-CF with participants ≥12 years performing up to 4 h per week of vigorous physical activity were used for this project. Multivariable models were computed to study associations between CFRD and VO2peak (mL.min-1) adjusting for a set of pre-defined covariates: age, sex, weight, forced expiratory volume in 1 s (FEV1), breathing reserve index, Pseudomonas aeruginosa infection, and physical activity (aerobic step counts from pedometry). Variables were selected based on their potential confounding effect on the association between VO2peak and CFRD. RESULTS Among 117 randomized individuals, 103 (52% female) had a maximal exercise test and were included in the analysis. Participants with (n = 19) and without (n = 84) CFRD did not differ in FEV1, physical activity, nutritional status, and other clinical characteristics. There were also no differences in VO2peak (mL.min-1 or mL.kg-1.min-1 or% predicted). In the final multivariable model, all pre-defined covariates were significant predictors of VO2peak (mL.min-1), however CFRD [coefficient 82.1, 95% CI -69.5 to 233.8, p = 0.28] was not. CONCLUSIONS This study suggests no meaningful differences in VO2peak between people with and without CFRD given comparable levels of physical activity.
Collapse
Affiliation(s)
- Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Lothar Stein
- Hannover Medical School, Institute of Sports Medicine, Hannover, Germany
| | - Chantal Karila
- Service de pneumologie et allergologie pédiatriques - Hôpital Necker Enfants malades - APHP - Université Paris Descartes, Paris, France
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - David M Orenstein
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA
| | - Larry C Lands
- Montreal Children's Hospital - McGill University Health, Montreal, QC, Canada
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ernst Eber
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | | |
Collapse
|
5
|
Prentice B, Nicholson M, Lam GY. Cystic fibrosis related diabetes (CFRD) in the era of modulators: A scoping review. Paediatr Respir Rev 2022:S1526-0542(22)00086-0. [PMID: 36581478 DOI: 10.1016/j.prrv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Cystic fibrosis-related diabetes (CFRD) is a common complication of CF that increases in incidence as patients age. Poor glycemic control has been shown to negatively impact lung function and weight, resulting in higher risk of recurrent pulmonary exacerbations. With the advent of highly effective modulator therapies (HEMT), patients with CF are living longer and healthier lives. Consequently, CFRD and its microvascular complications are rising in prominence, becoming one of the most urgent clinical concerns. As HEMT were developed with the primary focus of improving pulmonary outcomes, it is not clear from the original phase III studies what the short- or long-term benefits of modulators might be on CFRD development and trajectory. In this review, we will examine the pathophysiology of CFRD, summarize and synthesize the available evidence of HEMT impact on CFRD and describe the emerging research needs in this field.
Collapse
Affiliation(s)
- Bernadette Prentice
- Department of Respiratory Medicine, Sydney Children's Hospital, Randwick Australia; Molecular and Integrative Cystic Fibrosis (miCF) Research Centre, Randwick, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Randwick, Australia
| | - Mike Nicholson
- Division of Respirology, Department of Medicine, Western University, Ontario, Canada
| | - Grace Y Lam
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta, Canada.
| |
Collapse
|
6
|
Sandouk Z, Nachawi N, Simon R, Wyckoff J, Putman MS, Kiel S, Soltman S, Moran A, Moheet A. Coronary artery disease in patients with cystic fibrosis - A case series and review of the literature. J Clin Transl Endocrinol 2022; 30:100308. [PMID: 36267108 DOI: 10.1016/j.jcte.2022.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022] Open
Abstract
Progressive obstructive pulmonary disease is the primary life-shortening complication in people with Cystic Fibrosis (CF); improvement in life expectancy has led to increased prevalence of non-pulmonary complications. Patients with CF are considered to be at low risk for coronary artery disease (CAD). We report here a case series of six patients with CF with and without known cystic fibrosis related diabetes (CFRD) who had acute myocardial infarction (AMI) requiring coronary stent placement. This was a heterogeneous group of patients, without a clear pattern of consistent risk factors. Interestingly, most patients in this cohort had low LDL. In this review, we discuss risk factors of cardiovascular disease (CVD) that may apply to the CF population. While CAD is rare in people with CF, it does occur. We postulate that the risk will grow with increased longevity and the increased prevalence of co-morbidities such as obesity and dyslipidemia.
Collapse
|
7
|
Scully KJ, Marchetti P, Sawicki GS, Uluer A, Cernadas M, Cagnina RE, Kennedy JC, Putman MS. The effect of elexacaftor/tezacaftor/ivacaftor (ETI) on glycemia in adults with cystic fibrosis. J Cyst Fibros 2022; 21:258-263. [PMID: 34531155 PMCID: PMC8918034 DOI: 10.1016/j.jcf.2021.09.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cystic fibrosis related diabetes (CFRD) is associated with pulmonary decline and compromised nutritional status. Emerging data suggest that CFTR dysfunction may play a direct role in the pathogenesis of CFRD; however, studies investigating the effect of CFTR modulators on glycemic outcomes in patients with cystic fibrosis (CF) have shown mixed results. The impact of elexacaftor-tezacaftor-ivacaftor (ETI) on glycemic control is currently unknown. Our objective was to investigate the effect of ETI initiation on glycemia in adults with CF using continuous glucose monitoring (CGM). METHODS In this prospective observational study, 34 adults with CF and at least one F508del CFTR mutation wore CGM sensors for 14 days prior to starting ETI and again 3-12 months after ETI initiation. Hypoglycemia symptoms were queried at each visit, and most recent anthropometric measures and spirometry data were obtained by chart review. RESULTS Twenty-three participants completed the study. Compared to baseline, average glucose (AG), standard deviation (SD), % time >200 mg/dL, and peak sensor glucose decreased with ETI treatment, and % time in target range 70-180 mg/dL increased. Improvements in glycemic parameters were most notable in individuals with CFRD. There was no significant change in CGM-measured or self-reported hypoglycemia before and after ETI initiation. CONCLUSION Initiation of ETI in adults with CF was associated with improvement CGM-derived measures of hyperglycemia and glycemic variability with no effect on hypoglycemia. Further studies are needed to investigate underlying etiology of these changes and the long-term impact of ETI on glycemic control in patients with CF.
Collapse
Affiliation(s)
- Kevin J Scully
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, Harvard Medical School, Boston MA
| | - Peter Marchetti
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA
| | - Gregory S. Sawicki
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA
| | - Ahmet Uluer
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston MA
| | - Manuela Cernadas
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston MA
| | - Rebecca E. Cagnina
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston MA
| | - John C. Kennedy
- Harvard Medical School, Boston MA, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston MA
| | - Melissa S. Putman
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, Harvard Medical School, Boston MA, Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
8
|
Desimone ME, Sherwood J, Soltman SC, Moran A. Telemedicine in cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100270. [PMID: 34765457 PMCID: PMC8571077 DOI: 10.1016/j.jcte.2021.100270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
Cystic Fibrosis (CF) requires lifetime multidisciplinary care to manage both pulmonary and extra pulmonary manifestations. The median age of survival for people with CF is rising and the number of adults with CF is expected to increase dramatically over the coming years. People with CF have better outcomes when managed in specialty centers, however access can be limited. Telemedicine and technology-based care solutions may help to overcome barriers to availability and improve access. This review outlines the use of telehealth for CF management. Telehealth has been utilized for CF across a broad variety of indications, even prior to the COVID-19 pandemic, and in general has been well accepted by patients and providers. There are a paucity of data, however, related to health outcomes, and the healthcare utilization specific to CF and its related comorbidities. Future studies are needed to address the questions of health outcomes, cost, burdens of telehealth and barriers to implementation.
Collapse
Affiliation(s)
- Marisa E. Desimone
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Upstate Medical University 750 East Adams Street, Syracuse, NY 13210, USA
| | - Jordan Sherwood
- Division of Pediatric Endocrinology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sarah C. Soltman
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, 3270 SW Pavilion Loop, Portland, OR 97239, USA
| | - Antoinette Moran
- Division of Pediatric Endocrinology, University of Minnesota, 2512 S 7th Street, Minneapolis, MN 55454, USA
| |
Collapse
|
9
|
Abstract
The prevalence of obesity in patients with cystic fibrosis (CF) is increasing and around one-third of adults with CF are now overweight or obese. The causes of excess weight gain in CF are likely multifactorial, including: adherence to the high-fat legacy diet, reduced exercise tolerance, therapeutic advances, and general population trends. Increased weight has generally been considered favorable in CF, correlating with improved pulmonary function and survival. While the optimal BMI for overall health in CF is unknown, most studies demonstrate minimal improvement in pulmonary function when BMI exceeds 30 kg/m2. Dyslipidemia and cardiovascular disease are important co-morbidities of obesity in the general population, but are uncommon in CF. In people with CF, obesity is associated with hypertension and higher cholesterol levels. With longer life expectancy and rising obesity rates, there may be an increase in cardiovascular disease among people with CF in coming years. Overweight CF patients are more likely to be insulin resistant, taking on features of type 2 diabetes. Treating obesity in people with CF requires carefully weighing the metabolic risks of overnutrition with the impact of low or falling BMI on lung function. This article describes current knowledge on the epidemiology, causes, consequence, and treatment of obesity in people with CF.
Collapse
Affiliation(s)
- Katherine A. Kutney
- Department of Pediatrics, Division of Pediatric Endocrinology, University Hospitals, Rainbow Babies and Children’s Hospital Case Western Reserve University, 11100 Euclid Ave, Suite 737, Cleveland, OH 44106, USA
| | - Zahrae Sandouk
- Department of Internal Medicine, Division of Endocrinology, University of Michigan, USA
| | - Marisa Desimone
- Division of Endocrinology, Diabetes, and Metabolism, SUNY Upstate Medical University, USA
| | - Amir Moheet
- Department of Medicine, University of Minnesota, USA
| |
Collapse
|
10
|
Hicks R, Marks BE, Oxman R, Moheet A. Spontaneous and iatrogenic hypoglycemia in cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100267. [PMID: 34745906 PMCID: PMC8551648 DOI: 10.1016/j.jcte.2021.100267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/02/2021] [Accepted: 10/10/2021] [Indexed: 12/12/2022]
Abstract
Spontaneous episodes of hypoglycemia can occur in people with cystic fibrosis (CF) without diabetes, who are not on glucose lowering medications. Spontaneous hypoglycemia in CF could occur both in the fasting or postprandial state (reactive hypoglycemia). The pathophysiology of fasting hypoglycemia is thought to be related to malnutrition and increased energy expenditure in the setting of inflammation and acute infections. Reactive hypoglycemia is thought to be due to impaired first phase insulin release in response to a glucose load, followed by a delayed and extended second phase insulin secretion; ineffective counterregulatory response to dropping glucose levels may also play a role. The overall prevalence of spontaneous hypoglycemia varies from 7 to 69% as examined with oral glucose tolerance test (OGTT) or with continuous glucose monitoring (CGM) under free living conditions. Spontaneous hypoglycemia in CF is associated with worse lung function, higher hospitalization rates, and worse clinical status. In addition, patients with CF related diabetes on glucose-lowering therapies are at risk for iatrogenic hypoglycemia. In this article, we will review the pathophysiology, prevalence, risk factors, clinical implications, and management of spontaneous and iatrogenic hypoglycemia in patients with CF.
Collapse
Affiliation(s)
- Rebecca Hicks
- Division of Pediatric Endocrinology, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave., MDCC 22-315, Los Angeles, CA, USA
| | - Brynn E Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Ross Hall, 2300 Eye Street, NW, Washington, DC, USA
| | - Rachael Oxman
- Division of Endocrinology, Diabetes and Metabolism, UCLA Santa Monica Medical Center, 2020 Santa Monica Boulevard, Suite 550, Santa Monica, CA, USA
| | - Amir Moheet
- Division of Endocrinology, Diabetes and Metabolism, University of Minnesota, 420 Delaware Street SE, MMC 101, Minneapolis, MN, USA
| |
Collapse
|
11
|
Rosanio FM, Mozzillo E, Cimbalo C, Casertano A, Sepe A, Raia V, Franzese A, Tosco A. Diabetes outbreak during COVID19 lock-down in a prediabetic patient with cystic fibrosis long treated with glargine. Ital J Pediatr 2021; 47:121. [PMID: 34078438 PMCID: PMC8170445 DOI: 10.1186/s13052-021-01076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cystic Fibrosis Related Diabetes (CFRD) is a frequent comorbidity of patients with Cystic Fibrosis (CF). A worsening of clinical conditions appears before CFRD. It has been demonstrated a decline in pulmonary function and nutritional status also in patients with prediabetes. Few trials show that insulin may be beneficial in prediabetic CF patients, to date guidelines do not recommend for this condition. CASE PRESENTATION We report a case of a patient treated with insulin glargine at 13 years, due to glycemic intolerance, and with Lumacaftor/Ivacaftor at 15 years. A reduction of pulmonary exacerbations was observed after glargine therapy, also confirmed after the starting of Lumacaftor/ Ivacaftor in this patient. Pulmonary function improved only after the first year of glargine therapy, then a deterioration appeared due to the natural history of CF lung damage. During the COVID-19 lockdown, poor adherence to care contributed to diabetes mellitus onset needing high insulin requirements. After two weeks the patient returned to prediabetic condition and his previous dose of glargine. CONCLUSIONS our case highlights firstly that insulin glargine has contributed to preserve him from further clinical worsening due to prediabetes in the years before pandemic, secondly the negative impact of COVID-19 lockdown on the clinical course of a chronic disease as CF.
Collapse
Affiliation(s)
- Francesco Maria Rosanio
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy.
| | - Chiara Cimbalo
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Alberto Casertano
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Angela Sepe
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Valeria Raia
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Adriana Franzese
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Antonella Tosco
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| |
Collapse
|
12
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
13
|
Chan CL, Ode KL, Granados A, Moheet A, Moran A, Hameed S. Continuous glucose monitoring in cystic fibrosis - A practical guide. J Cyst Fibros 2020; 18 Suppl 2:S25-S31. [PMID: 31679725 DOI: 10.1016/j.jcf.2019.08.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
Our ability to monitor blood glucose levels has become increasingly accurate over the last few decades. Continuous glucose monitoring (CGM) technology now allows providers and patients the ability to monitor glucose levels retrospectively as well as in real-time for diabetes management. CGM also provides the ability to study glucose patterns and trends for insight into the pathophysiology and natural history of disease. CGM captures a more complete picture of glucose profiles than traditional measures of glycemia such as the hemoglobin A1c or self-monitoring of blood glucose levels. This article provides a review of the history of glucose monitoring, a review of the literature pertaining to CGM with a focus on studies in patients with cystic fibrosis, and discusses practical uses of CGM technology and its application for the evaluation and management of cystic fibrosis related diabetes.
Collapse
Affiliation(s)
- Christine L Chan
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA.
| | - Katie Larson Ode
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA
| | - Andrea Granados
- Department of Pediatrics, Washington University School of Medicine in St. Louis, MO, USA
| | - Amir Moheet
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Shihab Hameed
- University of New South Wales, Australia; Sydney Children's Hospital, Randwick, Australia; University of Sydney, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| |
Collapse
|
14
|
Bernhardt IT, Moore P, Currie S, Jefferies CA. Acute hyperosmolar hyperglycaemic state in cystic fibrosis-related diabetes caused by glucocorticoid and itraconazole interaction. J Cyst Fibros 2021; 20:330-2. [PMID: 32928702 DOI: 10.1016/j.jcf.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/12/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022]
Abstract
Hyperosmolar hyperglycaemic state (HHS) has not previously been reported in cystic fibrosis-related diabetes (CFRD). We report the case of a 15-year old boy with stable CFRD who developed acute HHS after treatment with glucocorticoids and itraconazole for presumed allergic broncho-pulmonary aspergillosis (ABPA). This case highlights the dangerous and preventable combination of high glucose intake, glucocorticoids and itraconazole inhibition of CYP3A4 (with resultant glucocorticoid accumulation) that can result in a state of life- threatening HHS in an adolescent with previously stable CFRD.
Collapse
|
15
|
Armaghanian N, Atkinson F, Taylor N, Kench A, Brand-Miller J, Markovic T, Steinbeck K. Dietary intake in cystic fibrosis and its role in glucose metabolism. Clin Nutr 2019; 39:2495-2500. [PMID: 31818530 DOI: 10.1016/j.clnu.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/05/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dietary intervention in cystic fibrosis (CF) has historically focused on high-energy diets to address malnutrition, with little attention on diet quality. With increased survival, CF complications such as impaired glucose tolerance (IGT) and cystic fibrosis related diabetes (CFRD) have increased in prevalence. In the absence of consensus on the management of IGT, the role of dietary intake, specifically carbohydrate quality, requires consideration. AIMS The aims of this study were to: 1) determine nutritional quality of dietary intake at an adult CF clinic and compare this to the Australian Dietary Guidelines 2) explore relationships between dietary intake, including glycaemic index (GI) and glycaemic load (GL), and glucose response variables using continuous glucose monitoring (CGM). METHODS Adults attending a Sydney hospital were recruited to undergo CGM for five-seven days and record dietary intake using a food record over the CGM period. The relationship between variables of dietary intake, including GI and GL and variables of glycaemic response, including mean amplitude of glycaemic excursions (MAGE), percentage of time in hyperglycaemic and euglycaemic range, were determined. RESULTS Eighteen participants completed the study with 87 full days of dietary and CGM data. Dietary intake was higher than recommendations in the Australian Dietary Guidelines in relation to grains and protein foods and only slightly higher in saturated fat. Bivariate correlations showed dietary GI was significantly positively associated with percentage of time in hyperglycaemic range. Dietary GL was significantly associated with SD, MAGE and percentage of time in euglycaemic range on CGM. Results remained significant when controlled for energy intake in partial correlation analyses. CONCLUSIONS This study suggests GI and GL may be important dietary factors influencing glucose metabolism in CF. Further studies exploring low GI or GL diets as a dietary intervention in CF are the next step.
Collapse
Affiliation(s)
- Natasha Armaghanian
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Fiona Atkinson
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
| | - Nicole Taylor
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andrea Kench
- Nutrition and Dietetics Department, Children's Hospital at Westmead, Westmead, Australia; Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, Australia
| | - Jennie Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
| | - Tania Markovic
- The Boden Institute, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Metabolism & Obesity Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate Steinbeck
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Westmead, Australia
| |
Collapse
|
16
|
Sun X, Yi Y, Liang B, Yang Y, He N, Ode KL, Uc A, Wang K, Gibson-Corley KN, Engelhardt JF, Norris AW. Incretin dysfunction and hyperglycemia in cystic fibrosis: Role of acyl-ghrelin. J Cyst Fibros 2019; 18:557-565. [PMID: 30738804 DOI: 10.1016/j.jcf.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 01/05/2019] [Accepted: 01/21/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Insulin secretion is insufficient in cystic fibrosis (CF), even before diabetes is present, though the mechanisms involved remain unclear. Acyl-ghrelin (AG) can diminish insulin secretion and is elevated in humans with CF. METHODS We tested the hypothesis that elevated AG contributes to reduced insulin secretion and hyperglycemia in CF ferrets. RESULTS Fasting AG was elevated in CF versus non-CF ferrets. Similar to its effects in other species, AG administration in non-CF ferrets acutely reduced insulin, increased growth hormone, and induced hyperglycemia. During oral glucose tolerance testing, non-CF ferrets had responsive insulin, glucagon like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) levels and maintained normal glucose levels, whereas CF ferrets had insufficient responses and became hyperglycemic. Interestingly in wild-type ferrets, the acyl-ghrelin receptor antagonist [D-Lys3]-GHRP-6 impaired glucose tolerance, and abolished insulin, GLP-1, and GIP responses during glucose tolerance testing. By contrast, in CF ferrets [D-Lys3]-GHRP-6 improved glucose tolerance, enhanced the insulin-to-glucose ratio, but did not impact the already low GLP-1 and GIP levels. CONCLUSIONS These results suggest a mechanism by which elevated AG contributes to CF hyperglycemia through inhibition of insulin secretion, an effect magnified by low GLP-1 and GIP. Interventions that lower ghrelin, ghrelin action, and/or raise GLP-1 or GIP might improve glycemia in CF.
Collapse
Affiliation(s)
- Xingshen Sun
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA
| | - Yaling Yi
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA
| | - Bo Liang
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA
| | - Yu Yang
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA
| | - Nan He
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA
| | - Katie Larson Ode
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA 52242, USA; Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA
| | - Aliye Uc
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA 52242, USA; Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA
| | - Kai Wang
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA
| | - Katherine N Gibson-Corley
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA 52242, USA; Department of Pathology, University of Iowa, Iowa City, IA 52242, USA
| | - John F Engelhardt
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Andrew W Norris
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA 52242, USA; Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA; Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA.
| |
Collapse
|
17
|
Chan CL, Vigers T, Pyle L, Zeitler PS, Sagel SD, Nadeau KJ. Continuous glucose monitoring abnormalities in cystic fibrosis youth correlate with pulmonary function decline. J Cyst Fibros 2018; 17:783-790. [PMID: 29580828 PMCID: PMC6151303 DOI: 10.1016/j.jcf.2018.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/23/2018] [Accepted: 03/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND To characterize glucose patterns with continuous glucose monitoring (CGM) in cystic fibrosis (CF) and assess relationships between CGM and clinical outcomes. METHODS 110 CF youth and healthy controls (HC), 10-18 years, wore CGM up to 7 days. Correlations between CGM and lung function and BMI z-score change over the prior year were determined. RESULTS Multiple CGM measures were higher in CF Normal Glycemic (CFNG) youth versus HC (peak glucose, excursions >140 mg/dl/day, %time > 140 mg/dl, standard deviation (SD) and mean amplitude of glycemic excursions (MAGE)). Hypoglycemia was no different among groups. In CF, decline in FEV1% and FVC% correlated with maximum CGM glucose, excursions >200 mg/dl/day, SD, and MAGE. CONCLUSIONS CFNG youth have higher glucoses and glucose variability than HC on CGM. Higher and more variable glucoses correlate with lung function decline. Whether earlier treatment of CGM abnormalities improves lung function in CF requires further study.
Collapse
Affiliation(s)
- Christine L Chan
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Timothy Vigers
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Laura Pyle
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Philip S Zeitler
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Scott D Sagel
- Department of Pediatrics, Division of Pediatric Pulmonology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| |
Collapse
|
18
|
Li A, Vigers T, Pyle L, Zemanick E, Nadeau K, Sagel SD, Chan CL. Continuous glucose monitoring in youth with cystic fibrosis treated with lumacaftor-ivacaftor. J Cyst Fibros 2018; 18:144-149. [PMID: 30104123 DOI: 10.1016/j.jcf.2018.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/22/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effects of lumacaftor-ivacaftor therapy on glycemia have not been thoroughly investigated. Continuous glucose monitoring (CGM) provides detailed information about glycemic patterns and detects glucose abnormalities earlier than traditional screening tools for diabetes. METHODS CGM measures, HbA1c, and oral glucose tolerance test (OGTT) results were collected and within-subject results compared in F508del homozygous youth with CF before and after initiation of lumacaftor-ivacaftor using the Wilcoxon signed-rank test. RESULTS Nine youth with CF (6 males, median age 12.7 years) were enrolled. CGM was performed in all participants before (median 26 weeks) and after lumacaftor-ivacaftor (median 29 weeks). HbA1c and fasting plasma glucose increased (p = .02) after lumacaftor-ivacaftor initiation. No changes in OGTT 1 h or 2 h glucose nor CGM measures were observed overall. When analyzed by sex, males showed lower glycemic variability, as reflected by the mean amplitude of glycemic excursions, on the post-treatment CGM. CONCLUSIONS Glycemic abnormalities persisted in CF patients treated with lumacaftor-ivacaftor, although sex-dependent differences in glycemic response to treatment may exist.
Collapse
Affiliation(s)
- Angel Li
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Tim Vigers
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Laura Pyle
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Edith Zemanick
- Department of Pediatrics, Division of Pediatric Pulmonology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kristen Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Scott D Sagel
- Department of Pediatrics, Division of Pediatric Pulmonology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christine L Chan
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| |
Collapse
|
19
|
Zoni AC, Domínguez-Berjón MF, Esteban-Vasallo MD, Sendra JM, Astray-Mochales J. Epidemiology of cystic fibrosis-related diabetes in Madrid (Spain) and frequency of hospitalization. Eur J Intern Med 2017; 42:e14-e15. [PMID: 28336126 DOI: 10.1016/j.ejim.2017.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/13/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Ana Clara Zoni
- Directorate-General for Public Health, Madrid Regional Health Authority, C/ San Martín de Porres 6, 1°, 28035 Madrid, Spain.
| | - M Felicitas Domínguez-Berjón
- Directorate-General for Public Health, Madrid Regional Health Authority, C/ San Martín de Porres 6, 1°, 28035 Madrid, Spain.
| | - María D Esteban-Vasallo
- Directorate-General for Public Health, Madrid Regional Health Authority, C/ San Martín de Porres 6, 1°, 28035 Madrid, Spain.
| | - Juan Manuel Sendra
- Directorate-General for Public Health, Madrid Regional Health Authority, C/ San Martín de Porres 6, 1°, 28035 Madrid, Spain.
| | - Jenaro Astray-Mochales
- Directorate-General for Public Health, Madrid Regional Health Authority, C/ San Martín de Porres 6, 1°, 28035 Madrid, Spain.
| |
Collapse
|
20
|
Burgess JC, Bridges N, Banya W, Gyi KM, Hodson ME, Bilton D, Simmonds NJ. HbA1c as a screening tool for cystic fibrosis related diabetes. J Cyst Fibros 2016; 15:251-7. [PMID: 25869326 DOI: 10.1016/j.jcf.2015.03.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/22/2015] [Accepted: 03/24/2015] [Indexed: 11/24/2022]
Abstract
AIMS Early diagnosis of cystic fibrosis (CF) related diabetes (CFRD) is important to improve outcomes. International guidelines recommend an oral glucose tolerance test (OGTT) for all CF patients aged ≥10 years - this approach is controversial. The aim of this study was to develop an effective screening tool and reduce the need for a universal OGTT. METHODS Adult CF patients (without CFRD) attending an annual review assessment were recruited prospectively (March 2009-July 2012) into two sequential studies - a primary investigative study followed by validation study. All patients underwent an OGTT and were simultaneously screened by predetermined biochemical/clinical criteria to identify their risk of CFRD. A sensitivity/specificity analysis was performed using the World Health Organisation diabetes criteria as gold standard; modifications were made to improve the screening tool's accuracy and determine the optimal screening thresholds. This was tested in the validation study. RESULTS 429 patients (primary, n=94; validation, n=335: mean age=31.7 ± 10.4(SD), 43% female, 77% on pancreatic supplements). Primary study: in predicting a positive OGTT, the test sensitivity was 66.7% and specificity 60%. HbA1c was carried over to the validation study as it was the most discriminative (optimal threshold ≥5.8% (40 mmol/mol); receiver operating curve, ROC, score 0.60). Validation study: the number of patients with a normal, impaired and diabetic OGTT was 268(80%), 51(15.2%) and 16(4.8%), respectively. HbA1c provided a test sensitivity, specificity and ROC score of 93.8%, 53.0% and 0.73, respectively. CONCLUSIONS The use of HbA1c ≥ 5.8%(40 mmol/mol) is an effective tool for CFRD screening and reduced the need for an OGTT by 50.7%.
Collapse
|
21
|
Perano S, Rayner CK, Couper J, Martin J, Horowitz M. Cystic fibrosis related diabetes--a new perspective on the optimal management of postprandial glycemia. J Diabetes Complications 2014; 28:904-11. [PMID: 25060530 DOI: 10.1016/j.jdiacomp.2014.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 02/07/2023]
Abstract
As the average life expectancy of patients with cystic fibrosis (CF) improves, the long term co-morbidities assume increasing importance. CF related diabetes (CFRD) has adverse effects on both nutrition and pulmonary function, and is associated with increased mortality. Abnormalities of glucose metabolism in CF represent a continuum; however the predominant abnormality is postprandial, not pre-prandial, glycemia. Insulin is currently recommended as the treatment of choice for CFRD, but its use is associated with a number of limitations, including hypoglycemia. Both the rate of gastric emptying and the consequent release of the 'incretin' hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like-peptide-1 (GLP-1), from the gut are important determinants of overall glycemic control, particularly postprandial glycemia. Both are abnormal in conditions associated with exocrine pancreatic insufficiency. Incretin based therapies that have the capacity to slow gastric emptying and/or modulate the release of 'incretin' hormones, are now used widely in type 2 diabetes (T2D). This paper explores the determinants of glycemic control in CF, with a particular focus on the roles of gastric emptying and 'incretin' hormones, providing a rationale for the use of therapies that delay gastric emptying, including incretin mimetics, to minimize postprandial glycemia and improve nutritional status.
Collapse
Affiliation(s)
- S Perano
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, South Australia, Australia; Discipline of Paediatrics and Medicine, University of Adelaide, South Australia, Australia.
| | - C K Rayner
- Discipline of Paediatrics and Medicine, University of Adelaide, South Australia, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, South Australia, Australia
| | - J Couper
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, South Australia, Australia; Discipline of Paediatrics and Medicine, University of Adelaide, South Australia, Australia
| | - J Martin
- Department of Respiratory Medicine, Women's and Children's Hospital, South Australia, Australia
| | - M Horowitz
- Discipline of Paediatrics and Medicine, University of Adelaide, South Australia, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, South Australia, Australia
| |
Collapse
|