Glucose >200 mg/dL during Continuous Glucose Monitoring Identifies Adult Patients at Risk for Development of Cystic Fibrosis Related Diabetes.

J L Taylor-Cousar,C G St Clair,K M Pickard,A Wilson,C S Chacon,J A Nick,S J Brayshaw,M T Saavedra,C M Barboa,M K Sontag,M C Jones,D P Nichols,J S Janssen,F J Accurso

doi:10.1155/2016/1527932

Abstract

Rationale. Cystic fibrosis related diabetes (CFRD) is the most common comorbidity in patients with CF. In spite of increased screening, diagnosis, and treatment of CFRD, the mortality rate in patients with CFRD still far exceeds the mortality rate in those without CFRD. Guidelines suggest that screening for CFRD be performed annually using the 2-hour 75-gram oral glucose tolerance test (OGTT). Adherence to recommended screening has been poor, with only approximately one-quarter of adults with CF undergoing OGTT in 2014. Use of continuous glucose monitoring (CGM) for diagnosis may become an alternative. Objectives. Our objective was to determine whether abnormal CGM predicts subsequent development of CFRD, lung function, and body mass index (BMI) decline and increased rate of CF pulmonary exacerbations in adults with CF. Methods. In a prospective single center pilot trial from September 2009 to September 2010, 21 adult patients due for routine OGTT were recruited to complete simultaneous 3-day CGM and 2-hour 75 gram OGTT. Subsequently, clinical information was reviewed from 2008 to 2015. Conclusions. There was a moderate correlation between interpreted results of 2-hour OGTT and CGM (p = 0.03); CGM indicated a greater level of glucose impairment than OGTT. Glucose >200 mg/dL by CGM predicted development of CFRD (p = 0.0002).

Highlights

Advances in treatment have led to an increase in survival in people with cystic fibrosis (CF)
As patients age with CF, they experience an increased rate of complications, including cystic fibrosis related diabetes (CFRD) [1]
In adult patients with CF, continuous glucose monitoring (CGM) identified a greater degree of impaired glucose metabolism than the gold standard 2hour oral glucose tolerance test (OGTT)

Summary

Introduction

Advances in treatment have led to an increase in survival in people with cystic fibrosis (CF). As patients age with CF, they experience an increased rate of complications, including cystic fibrosis related diabetes (CFRD) [1]. The ferret CF model shows that early inflammation leads to pancreatic cell destruction and replacement with fibrosis [5]. These pathologic changes correspond to significant dysregulation of blood glucose and insulin. While patients with CF have not been observed to develop macrovascular complications of diabetes, microvascular complications are seen [6]. Diagnosis of CFRD is associated with poor nutrition status and decreased lung function and survival [7,8,9,10,11]

Objectives

Methods

Discussion

Conclusion