HbA1c as a screening tool for cystic fibrosis related diabetes

Burgess, J.C.; Bridges, Nicola; Banya, Winston; Gyi, Khin M.; Hodson, Margaret E.; Bilton, Diana; Simmonds, Nicholas J.

doi:10.1016/j.jcf.2015.03.013

Cited by 58 publications

(55 citation statements)

References 24 publications

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“…Some data suggest that there is no relationship between mean plasma glucose and glycated hemoglobin in patients with CFRD (35). However, data on the value of HbA 1c are conflicting with recent data suggesting an HbA 1c $5.8% as an effective tool for CFRD screening (36). Another possible explanation might be the persistence of endogenous insulin secretion, especially in the baseline state.…”

Section: Discussionmentioning

confidence: 94%

Does β-Cell Autoimmunity Play a Role in Cystic Fibrosis–Related Diabetes? Analysis Based on the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry

Konrad

Kapellen

Lilienthal³

et al. 2016

Diabetes Care

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OBJECTIVEResearch on b-cell autoimmunity in cystic fibrosis (CF)-related diabetes (CFRD) is still rare. We aimed to analyze the frequency of b-cell autoimmunity and the influence on age at diabetes onset, insulin requirement, type of insulin therapy, and hypoglycemic or ketoacidotic events in patients with CFRD compared with antibody-negative patients with CFRD in the Diabetes Patienten Verlaufsdokumentation (DPV) registry. RESEARCH DESIGN AND METHODSWe analyzed data of 837 patients with CFRD in the German/Austrian DPV database by multivariable mixed-regression modeling. RESULTSIn our cohort, 8.5% of patients with CFRD (n = 72) were found to be b-cell antibody positive. There was a female preponderance in this patient group: 65.3 vs. 57.6%. Diabetes onset (median [interquartile range]) was earlier (14.00 [10.15-15.90] vs. 16.10 [13.50-21.20] years; P < 0.005), and insulin dose/kg body weight was higher (0.95 [0.61-1.15] vs. 0.67 [0.33-1.04] IU/kg; P < 0.05). There were also differences in the type of insulin treatment. Insulin pump therapy was used significantly more often in patients with CFRD with b-cell autoimmunity (18.2 vs. 6.4%; P < 0.05). The differences for multiple daily injections (ICT) and conventional therapy (CT) were not significant (ICT: 67.7 vs. 79.0%; CT: 15.2 vs. 14.6). Oral antidiabetic agents were rarely used in both groups. Rate of severe hypoglycemia with coma and rate of ketoacidosis were higher in antibody-positive patients (hypoglycemia with coma: 8.0 vs. 1.4, P < 0.05; ketoacidosis: 9.3 vs. 0.9, P < 0.05). CONCLUSIONSPresence of b-cell autoantibodies in our cohort of patients with CFRD (8.5%) appeared to be greater than in the general population and was associated with female sex, earlier onset of diabetes, and higher insulin requirement. Insulin pump therapy was used significantly more often in patients with b-cell antibodies. Severe hypoglycemia and ketoacidosis were significantly more frequent in CFRD with b-cell autoimmunity compared with b-cell antibody-negative patients with CFRD.

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Section: Discussionmentioning

confidence: 94%

Does β-Cell Autoimmunity Play a Role in Cystic Fibrosis–Related Diabetes? Analysis Based on the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry

Konrad

Kapellen

Lilienthal³

et al. 2016

Diabetes Care

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“…Using a lower threshold as Burgess et al had suggested may reduce the requirement for OGTTs but may still not be acceptable [92]. In fact, Schnyder et al described a cohort of severely ill patients who were being evaluated for lung transplantation and analysed their measured HbA 1c.…”

Section: Hba 1c and Its Use In Screeningmentioning

confidence: 99%

Diagnosing cystic fibrosis-related diabetes: current methods and challenges

Prentice

Hameed

Verge

et al. 2016

Expert Review of Respiratory Medicine

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This review summarises the current understanding of the pathophysiology of CFRD, the issues associated with using oral glucose tolerance tests in CF and the challenges faced in making the diagnosis of CFRD. Medline database searches were conducted using search terms "Cystic Fibrosis Related Diabetes", "Cystic Fibrosis" AND "glucose", "Cystic Fibrosis" AND "insulin", "Cystic Fibrosis" AND "Diabetes". Additionally, reference lists were studied. Expert commentary: Increasing evidence points to early glucose abnormalities being clinically relevant in cystic fibrosis and as such novel diagnostic methods such as continuous glucose monitoring or 30 minute sampled oral glucose tolerance test (OGTT) may play a key role in the future in the screening and diagnosis of early glucose abnormalities in CF.

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“…If HbA1c is to have utility, lower levels will need to be considered as clinically important. An HbA1c ≥40 mmol/mol has been proposed as a diagnostic level for CFRD screening and is suggested to reduce the need for an OGTT by 50.7% [23]. A systematic review of screening tests for CFRD agreed that the sensitivity of HbA1c is too low to recommended it as a diagnostic test [24].…”

Section: Diagnosismentioning

confidence: 99%

A Practical Approach to Glucose Abnormalities in Cystic Fibrosis

Jones

Sainsbury

2016

Diabetes Ther

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Cystic fibrosis is a common genetic condition and abnormal glucose handling leading to cystic fibrosis-related diabetes (CFRD) is a frequent comorbidity. CFRD is mainly thought to be the result of progressive pancreatic damage resulting in beta cell dysfunction and loss of insulin secretion. Whilst Oral Glucose Tolerance Testing is still recommended for diagnosing CFRD, the relationship between glucose abnormalities and adverse outcomes in CF is complex and occurs at stages of dysglycaemia occurring prior to diagnosis of diabetes by World Health Organisation criteria. Insulin remains the mainstay of treatment of CF-related glucose abnormalities but the timing of insulin commencement, optimum insulin regime and targets of glycaemic control are not clear. These complexities are compounded by common issues with nutritional status, need for enteral feeding, steroid use and high disease burden on CF patients.

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HbA1c as a screening tool for cystic fibrosis related diabetes

Abstract: 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%.

Cited by 58 publications

References 24 publications

Does β-Cell Autoimmunity Play a Role in Cystic Fibrosis–Related Diabetes? Analysis Based on the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry

Does β-Cell Autoimmunity Play a Role in Cystic Fibrosis–Related Diabetes? Analysis Based on the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry

Diagnosing cystic fibrosis-related diabetes: current methods and challenges

A Practical Approach to Glucose Abnormalities in Cystic Fibrosis

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