Insulin and oral agents for managing cystic fibrosis-related diabetes

Abstract

This review has not found any significant conclusive evidence that long-acting insulins, short-acting insulins or oral hypoglycemic agents have a distinct advantage over one another in controlling hyperglycemia or clinical outcomes associated with cystic fibrosis-related diabetes. While some cystic fibrosis centers use oral medications to help control diabetes, the Cystic Fibrosis Foundation (USA) clinical practice guidelines support the use of insulin therapy and this remains the most widely-used treatment method. Randomized controlled trials specifically related to controlling diabetes with this impact on the course of pulmonary disease process in cystic fibrosis continue to be a high priority.There is no demonstrated advantage yet established for using oral hypoglycemic agents over insulin, and further trials need to be evaluated to establish whether there is clear benefit for using hypoglycemic agents. Agents that potentiate insulin action, especially agents with additional anti-inflammatory potential should be further investigated to see if there may be a clinical advantage to adding these medications to insulin as adjuvant therapy.

ISPAD Clinical Practice Consensus Guidelines 2018: Management of cystic fibrosis-related diabetes in children and adolescents

“…Oral diabetes agents are currently not recommended in CFRD. A Cochrane review did not identify any randomized controlled trials other than the CFRDT Trial, where the insulin secretagogue repaglinide was not able to produce sustained weight gain in individuals with CFRD without fasting hyperglycemia . Results of a recently published multicenter European study comparing insulin and repaglinide showed no differences in HbA1c, body mass index (BMI), lung function, or adverse events between the two treatments after 2 years of therapy; they suggest that repaglinide could be considered for treatment of early CFRD .…”

Open randomised prospective comparative multi-centre intervention study of patients with cystic fibrosis and early diagnosed diabetes mellitus

“…Guidelines recommend insulin as first line treatment [2]. Nevertheless there are many centers which use oral antidiabetic drugs for treatment of CFRD [3]. The reasons for this off label use might be the hope to reduce the treatment burden which is even without CFRD very high in CF [12,13].…”

“…Therefore a direct comparison of the effect of repaglinide versus insulin on BMI, HbA1c and FEV1%pred was not presented. The actual Cochrane report [3] regarding “Insulin and oral agents for managing cystic fibrosis-related diabetes” stated that further studies are needed to establish whether there is clear benefit for hypoglycemic agents. We expect that the results of our study will help to address this clinical need.…”

“…But no data are available to answer the question if CFRD must always initially be treated by insulin [3]. Several centres report the successful management of CF-related diabetes using oral anti-diabetic drugs at least for some years [4,5].…”

“…But no data are available to answer the question if CFRD must always initially be treated by insulin [3]. Several centres report the successful management of CF-related diabetes using oral anti-diabetic drugs at least for some years [4,5]. Oral therapies would be less invasive for a patient group which is highly traumatized by a very demanding pharmaceutical therapy (including antibiotics, pancreatic enzymes, bronchodilators, mucolytic agents) in addition to physiotherapy.…”