Glycemic control and FEV1 recovery during pulmonary exacerbations in pediatric cystic fibrosis-related diabetes

Okoniewski, William; Hughan, Kara S.; Weiner, G.; Weiner, Daniel J.; Forno, Erick

doi:10.1016/j.jcf.2019.12.016

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…Mean time spent > 140 mg/dL was 25.3% (16.9), and median (IQR) time spent > 200 mg/dL was 4% (1)(2)(3)(4)(5)(6)(7)(8)(9). Hyperglycaemia was mostly postprandial in those who showed hyperglycaemia on CGM.…”

Section: Re Sultsmentioning

confidence: 97%

“…CF‐related diabetes (CFRD) development is associated with worse lung disease and accelerated lung function decline, 4 and insulin therapy can improve that decline 5 . In a retrospective study, poor glycemic control during exacerbations in children with CFRD was associated with poorer FEV1 recovery, 6 suggesting that untreated hyperglycaemia can affect recovery from exacerbations. Two small studies in CF patients without diabetes reported contradicting results, with one study finding that patients exhibit diabetic glucose tolerance during exacerbations that returns to normal with recovery 7 and the other finding little difference in glucose tolerance status during exacerbations compared to clinical stability 8 .…”

Section: Introductionmentioning

confidence: 99%

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Acute hyperglycaemia in cystic fibrosis pulmonary exacerbations

Merjaneh

Toprak

McNamara

et al. 2020

Endocrino Diabet & Metabol

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Background Hyperglycaemia may contribute to failure to recover from pulmonary exacerbations in cystic fibrosis (CF). We aimed to evaluate the prevalence and mechanism of hyperglycaemia during and post‐exacerbations. Methods Nine paediatric CF patients, not on insulin, hospitalized for intravenous antibiotics, underwent an oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM) upon admission (visit 1) and an OGTT 2 weeks (visit 2) and 6 weeks to 12 months later when at stable baseline (visit 3). Insulin and glucose levels were measured before, 30, 60 and 120 min after glucose ingestion during OGTT. Hyperglycaemia on OGTT was defined according to the American Diabetes Association criteria as abnormal OGTT or consistent with diabetes. Hyperglycaemia on CGM was defined as CGM time above 140 mg/dL > 4.5%. Results At visit 1, 8/9 patients had hyperglycaemia on both CGM and OGTT (2 diabetes and 6 abnormal OGTT). At visit 2, 5/8 had hyperglycaemia (all abnormal OGTT). At visit 3, (median (IQR) time since visit 1, 4.9 (3.8‐6.3) months), 5/7 had hyperglycaemia (2 diabetes and 3 abnormal OGTT). At visits 1, 2 and 3, respectively, mean (SD) 2‐hour OGTT glucose was 175.8 (42.3), 146.3 (31.9) and 176.9 (51.7) mg/dL. CGM time above 140 mg/dL at visit 1 was 25.3% (16.9). Insulin AUC decreased from visit 2 (median (IQR) 5449 (3321‐8123) mcIU‐min/mL) to visit 3 (3234 (2913‐3680) mcIU‐min/mL). Conclusion Hyperglycaemia is prevalent during paediatric CF exacerbations; it appears to improve with exacerbation treatment but to worsen later in association with decreased insulin secretion.

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Section: Re Sultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Acute hyperglycaemia in cystic fibrosis pulmonary exacerbations

Merjaneh

Toprak

McNamara

et al. 2020

Endocrino Diabet & Metabol

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“…Macrovascular disease is uncommon outside of case reports [1,4,5,113], and although screening for microvascular disease should be routinely undertaken [59], microvascular complications are uncommon until at least 5-10 years of CFRD with fasting hyperglycemia [57,114,115]. Therefore they are substantially predated by declines in lung function [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][116][117][118] and nutritional status [7, 9-12, 14, 117], both of which are significant predictors of early mortality in CF [10,11,16,18,25,56,119]. Four large cohort studies also report higher annual frequency in diabetic vs. non-diabetic CF patients of pulmonary exacerbations requiring intravenous antibiotics or hospitalization [10,21,39,120], and it was recently demonstrated that diabetic CF patients have reduced recovery of baseline forced expiratory volume in 1 sec as a percentage of predicted (FEV 1 %) following pulmonary exacerbations [116].…”

Section: Clinical Significance Of Early Glucose Abnormalities In Cf As Detected Using Various Glucose Measurement Techniques 31 Defining mentioning

confidence: 99%

Detection and Management of Early Glucose Abnormalities in Cystic Fibrosis

Theocharous¹,

Prentice²,

Verge³

et al. 2021

Cystic Fibrosis - Facts, Management and Advances

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With advances in technology, it is now possible to detect the emergence of glucose abnormalities in cystic fibrosis with improved sensitivity, and from a very early age. These abnormalities are increasingly recognized as predictors of clinical decline, raising the possibility that early intervention may slow or prevent this deterioration. In this chapter, we will review the available literature on methods of detecting glucose abnormalities in cystic fibrosis (random and fasting glucose, HbA1c, oral glucose tolerance testing, and continuous glucose monitoring), and detail their advantages and possible limitations in the interpretation of glycemic data. We will also discuss treatment outcomes of early intervention, prior to the diagnosis of diabetes as currently defined.

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“…Risk factors for CFRD include female gender, age, liver disease, and pancreatic insufficiency [ 11 , 12 , 13 ]. Moreover, CFRD is associated with a decline in lung and liver functions, impairments in weight gain and growth, impairment of pubertal development, depression, and increased morbidity and mortality [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The 2010 clinical care guidelines for CFRD recommend insulin as the mainstay of treatment.…”

Section: Introductionmentioning

confidence: 99%

Cystic Fibrosis-Related Diabetes in Poland

Rachel

Biesiadecki

Galiniak

2022

IJERPH

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Cystic fibrosis (CF) is the most common autosomal recessive inherited monogenic disease in Caucasians. As medical technology progresses and the quality of patient care improves, the survival time of patients with CF has increased, which results in more frequent comorbidities such as cystic fibrosis-related diabetes (CFRD). CFRD is the result of abnormal glucose metabolism characterized primarily by insulin deficiency, exacerbated periodically by insulin resistance. The aim of our study was to analyze the epidemiology of patients with CFRD in Poland on the basis of data collected from six CF treatment centers. Analyses were performed on 1157 CF patients who were treated at one of the six CF care centers. CFRD was diagnosed according to standard criteria. All data including demographics, types of CFTR mutations, CFRD duration, and microorganisms in the sputum were obtained from the patients’ medical history. Our study indicates that the prevalence of CFRD in Poland is 12.9%. CFRD was most often diagnosed between the ages of 11 and 20 (60% of patients), while 23% of patients were diagnosed between 21 and 30 years of age. Furthermore, we observed that approximately 3–5% of patients under the age of 10 had CFRD. We found out that the type of mutation did not affect the frequency of CFRD development. Factors that increased the risk of developing CFRD include underweight and chronic Pseudomonas aeruginosa infection. Due to the extended lifespan of CF patients, the number of CFRD patients is currently increasing. We believe that the results of our study may complement information from other studies or may be useful in planning health policy in Poland.

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Glycemic control and FEV1 recovery during pulmonary exacerbations in pediatric cystic fibrosis-related diabetes

Cited by 8 publications

References 25 publications

Acute hyperglycaemia in cystic fibrosis pulmonary exacerbations

Acute hyperglycaemia in cystic fibrosis pulmonary exacerbations

Detection and Management of Early Glucose Abnormalities in Cystic Fibrosis

Cystic Fibrosis-Related Diabetes in Poland

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