Abstract
BackgroundInsulin is the recommend therapeutic agent of choice for the management of Cystic Fibrosis Related Diabetes (CFRD), despite only sub-optimal reductions in glycemic control and increased morbidity and mortality reported by centers using this agent. The newer insulin sensitizing agents demonstrated to have anti-inflammatory mechanisms may provide an alternative management option for CFRD.MethodsA prospective case based therapeutic comparison between insulin, sulfonylurea, metformin and thiazolidinedione was observed over one decade with 20 CFRD patients diagnosed using American Diabetes Association guideline standards. Patients entering the study elected treatment based on risk and benefit information provided for treatment options. Patients receiving organ transplant or requiring combination diabetic medications were excluded from the study.ResultsNo statistical advantage was achieved regarding overall glycemic control for oral agents over insulin. Additional outcome measures including changes in weight, liver function testing and FEV1 were not statistically significant.ConclusionInsulin alone may not be the only therapeutic option in managing CFRD. Oral hypoglycemic agents were equally effective in treating CFRD and may provide an alternative class of agents for patients reluctant in using insulin.
Highlights
Insulin is the recommend therapeutic agent of choice for the management of Cystic Fibrosis Related Diabetes (CFRD), despite only sub-optimal reductions in glycemic control and increased morbidity and mortality reported by centers using this agent
This study reports the first clinical outcome for insulin sensitizing agents with potential anti-inflammatory activity in the management of CFRD
Our cystic fibrosis (CF) center has adopted a rational approach to managing CFRD based on this observational experience
Summary
Insulin is the recommend therapeutic agent of choice for the management of Cystic Fibrosis Related Diabetes (CFRD), despite only sub-optimal reductions in glycemic control and increased morbidity and mortality reported by centers using this agent. This guideline further recommends insulin as the therapeutic agent of choice in managing Cystic Fibrosis Related Diabetes (CFRD). Diabetic diets utilized for type 1 and 2 diabetes conflict with the high fat and carbohydrate diet required to compensate for the malabsorption associated with the majority of CF patients. This carbohydrate load further stresses glucose tolerance in CF that is associated with both impaired insulin secretion and insulin resistance [4]. Insulin deficiency progresses with increasing age, but is seldom absolute in CF and ketoaci-
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