Impaired glucose tolerance, body mass index and respiratory function in patients with cystic fibrosis: A systematic review

Iwanicki, C.; Logomarsino, John V.

doi:10.1111/crj.13019

Cited by 4 publications

(5 citation statements)

References 29 publications

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“…CFRD can cause poor growth and increase the risk of pulmonary exacerbations due to hyperglycaemia promoting bacterial growth and increased thickness of secretions 4 . Of note, a systematic review in 2019 6 showed no difference in Body Mass Index (BMI), Forced Expiratory Volume in 1 second (FEV 1 ) in patients with CF and impaired glucose tolerance when compared to those with normal glucose tolerance. Investigations to diagnosed diabetes include HbA1c and OGTT.…”

Section: Improving Screening In a Paediatric Cohort For Cystic Fibros...mentioning

confidence: 99%

Improving screening in a Paediatric cohort for cystic fibrosis related diabetes: a quality improvement project

Schultz

Wilson

2023

Preprint

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Background: There is considerable variation in recommendations from clinical practice guidelines on when and how to screen for glucose intolerance in people with cystic fibrosis (CF). In terms of glucose tolerance, the Australian Standards of Care state that blood glucose monitoring should be performed to exclude hyperglycaemia on a regular basis. Annual oral glucose tolerance test (OGTT) in patients 10 years or older should be considered and performed in patients with symptoms suggestive of glucose impairment or unexplained weight loss, growth failure or worsening respiratory disease. In 2018, 13 (14%) of the eligible 99 patients with CF ≥10 years old had an OGTT. Aims: To evaluate the added benefit of enhanced screening to children and adolescents with CF by improving screening to 50% by the end of 2020. Methods: A prospective cross-sectional quality improvement cycles was performed on patients in the CF clinic, ≥11 years for OGTT. Patients were excluded from OGTTs if they were prescribed insulin or prolonged oral/parenteral steroids. Multiple quality improvement initiatives were tried. Each intervention was done as a plan-do-study-act cycles with refinement between each. Results: Screening for CF related diabetes (CFRD) increased in 2020 to 60% of >10 year olds. Four patients had new results suggestive of CFRD and ten had new impaired glucose tolerance. The most successful strategy was sending letters to families. Conclusion: The Australian Standards of Care may require revision, as there may be a benefit of routine screening of all children at certain ages as opposed to waiting for symptoms.

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Section: Improving Screening In a Paediatric Cohort For Cystic Fibros...mentioning

confidence: 99%

Improving screening in a Paediatric cohort for cystic fibrosis related diabetes: a quality improvement project

Schultz

Wilson

2023

Preprint

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“…Отмечено, что показатель ОФВ 1 начинает снижаться за 2-4 года до постановки МЗСД [2,3,15]. Доказано, что снижение функции легких является ведущей причиной заболеваемости и смертности пациентов с МЗСД [5,19,20]. Следует отметить, что макро-и микрососудистые осложнения, в отличие от других типов СД, при МЗСД встречаются редко и не являются основной причиной смерти [5,20].…”

Section: Introductionunclassified

“…Получены неоднозначные данные, свидетельствующие об изменении ОФВ 1 и ИМТ. В одних исследованиях показано, что в предиабетический период уже отмечается снижение ОФВ 1 и ИМТ [19,27], в других исследованиях данных за изменения ОФВ 1 и ИМТ не получено [19]. Очевидно, что своевременное выявление НУО в период предиабета у детей с МВ является трудной и малоизученной задачей.…”

Section: Introductionunclassified

Comparison of the forms of carbohydrate metabolism in children with cystic fibrosis: A review

Liabina,

Tikhonovskiy,

Simonova

et al. 2024

Consilium Medicum

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Background. Forms of glucose metabolism disorders are one of the key processes in the course of cystic fibrosis (CF) and can be variable, starting with impaired glucose tolerance (IGT) and ending with cystic fibrosis-related diabetes (CFRD), which is the most dangerous complication, worsening the prognosis and outcome of disease. Decreased lung function and poor nutritional status are the leading causes of morbidity and mortality in patients with carbohydrate metabolism disorders (CMD). Materials and methods. The study included 85 children with CF. Patients underwent measurement of anthropometric parameters (height, weight) to assess nutritional status (NS), and spirometry test was used to assess pulmonary function (PF). Of these, 78 patients were assessed with an oral glucose tolerance test (OGTT) at 5 points (0 minutes, 30 minutes, 60 minutes, 90 minutes, 120 minutes) assessing the concentration of venous plasma glucose in mmol/l. The results of the OGTT were assessed in accordance with the diagnostic criteria for CFRD. Results. According to the Kruskal–Wallis test, the maximum volumetric flow rate during exhalation of 75% FVC (FEF 75) differed between different forms of carbohydrate metabolism (p=0.031). Other indicators of respiratory function didn’t have any significant differences. Using the Mann–Whitney test, pairwise comparisons were performed, so the FEF 75 indicator was statistically significantly lower in the group of children with CFRD than in other groups. There were no statistically significant differences when assessing Z-scores weight/age (WAZ) and height/age (HAZ) depending on the forms of carbohydrate metabolism. However, BMI/age Z-scores (BAZ) were statistically significantly lower in groups of children with CFRD than in other forms of carbohydrate metabolism. Conclusion. Children with CF in the period of prediabetes don’t have significant impairments in lung function and NS. These disorders are typical for children with CFRD.

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“…МЗСД обычно предшествуют преддиабетические состояния, в т. ч. нарушение гликемии натощак (НГН), неопределенная гликемия (indeterminate glycemia (INDET) и нарушение толерантности к глюкозе (НТГ) [4,5,10]. Согласно российским Клиническим рекомендациям по ведению взрослых и детей с кистозным фиброзом, опубликованным в 2021 г., и данным Американской диабетической ассоциации, диагностическим скринингом углеводного обмена является 2-часовой оральный глюкозотолерантный тест, который рекомендуется ежегодно проводить детям, начиная с 10-летнего возраста, а в некоторых случаях по показаниям тест может проводится и в более раннем возрасте [11,12] (табл.…”

Section: Introductionunclassified

Significance of fructosamine in the diagnosis of carbohydrate metabolism disorders in children with cystic fibrosis

et al. 2022

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Introduction. Cystic fibrosis associated (related) diabetes mellitus (CFDM) is one of the most common severe complications of cystic fibrosis. Today, the issue of the goodness of a single measurement of fasting blood glucose, glycated hemoglobin and fructosamine to assess the degree of carbohydrate metabolism disorders in children with cystic fibrosis is a subject of debate. The gold standard for diagnosing carbohydrate metabolism disorders (impaired fasting glycemia, various pre-diabetic conditions, diabetes mellitus) is the oral glucose tolerance test. Data about the diagnostic value of fructosamine for predicting CFDM aren’t dispositive. No credible studies of fructosamine in children with cystic fibrosis have been found in the Russian medical literature.Aim. To determine the diagnostic informative value of the blood fructosamine and other single-measured glycemic marker levels in the early diagnosis of carbohydrate metabolism disorders at the pre-diabetes stage in children with cystic fibrosis.Materials and methods. The results of laboratory tests and instrumental examinations of 87 children with cystic fibrosis aged 5–18 years were reviewed. A cross-sectional study of fructosamine, fasting blood sugar and glycated hemoglobin level (some patients underwent an oral glucose tolerance test), and liver fibroelastometry were also performed.Results and discussion. An increase in the fructosamine level was observed, which indicates a possible CFDM in children (p = 0.049): CFDM is highly likely, if the level of fructosamine is ≥255.5 µmol/l (reference ranges for children are 272–285 µmol/l; sensitivity = 57.1%, specificity = 85.2%). It has been found that children with cystic fibrosis and liver cirrhosis have increased fructosamine levels: cut-off = 253.0 µmol/l (Sn – 70.0%, Sp – 85.2%).Conclusion. The fructosamine level, a single determination of fasting blood glucose and glycated hemoglobin are not informative markers for the diagnosis of pre-diabetic conditions in cystic fibrosis in children. It is important to bear in mind that concomitant liver cirrhosis can affect the fructosamine levels. CFDM can be diagnosed at the lower fructosamine level, despite the generally accepted ranges.

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Impaired glucose tolerance, body mass index and respiratory function in patients with cystic fibrosis: A systematic review

Cited by 4 publications

References 29 publications

Improving screening in a Paediatric cohort for cystic fibrosis related diabetes: a quality improvement project

Improving screening in a Paediatric cohort for cystic fibrosis related diabetes: a quality improvement project

Comparison of the forms of carbohydrate metabolism in children with cystic fibrosis: A review

Significance of fructosamine in the diagnosis of carbohydrate metabolism disorders in children with cystic fibrosis

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