Insulin therapy in patients with cystic fibrosis in the pre-diabetes stage: a systematic review

Abstract

Objective:To elucidate whether insulin is effective or not in patients with cystic fibrosis before the diabetes mellitus phase.Data source:The study was performed according to the Prisma method between August and September 2014, using the PubMed, Embase, Lilacs and SciELO databases. Prospective studies published in English, Portuguese and Spanish from 2002 to 2014, evaluating the effect of insulin on weight parameters, body mass index and pulmonary function in patients with cystic fibrosis, with a mean age of 17.37 years before the diabetes mellitus phase were included.Data synthesis:Eight articles were identified that included 180 patients undergoing insulin use. Sample size ranged from 4 to 54 patients, with a mean age ranging from 12.4 to 28 years. The type of follow-up, time of insulin use, the dose and implementation schedule were very heterogeneous between studies.Conclusions:There are theoretical reasons to believe that insulin has a beneficial effect in the studied population. The different methods and populations assessed in the studies do not allow us to state whether early insulin therapy should or should not be carried out in patients with cystic fibrosis prior to the diagnosis of diabetes. Therefore, studies with larger samples and insulin use standardization are required.

Screening Methods for Diagnosing Cystic Fibrosis-Related Diabetes: A Network Meta-Analysis of Diagnostic Accuracy Studies

“…Recent guidelines recommend annual routine OGTT screening for people above the age of 10. Even though OGTT serves as a basis for defining CFRD, its thresholds were established in diabetes without CF, and were not designed to detect hyperglycaemia-associated risk of deterioration in lung function or under-nutrition [ 39 , 45 ]. Considering the practical challenges of OGTT and the low frequency of screening, according to the 2018 report of the Cystic Fibrosis Foundation patient registry (approximately 61.3% of children, aged between 10 and 17, and 33.8% of adults), the need for a more convenient screening method is urgent [ 3 ].…”

Trajectories of oral glucose tolerance testing in cystic fibrosis

“…Yet, the main clinical rationale for screening for CFRD is to determine which patients would benefit from insulin therapy to augment the catabolic effects of insulin insufficiency and glycemic excursions and subsequent deterioration in growth and lung function. A systemic review of insulin therapy in patients with glucose abnormalities other than diagnosed CFRD showed no consensus that early insulin therapy was beneficial 28 . In contrast, Frost et al 29 found that insulin therapy, in nondiabetic CF adults with hyperglycemia on CGM, was associated with significant improvements in mean ppFEV 1 , weight, and lung function decline.…”

Detection and Management of Early Glucose Abnormalities in Cystic Fibrosis

“…All this suggests that treatment of CF-related AGT may be beneficial. However, results are difficult to generalize, due to heterogeneity in studies' inclusions criteria, types of controls, and insulin regimens [166]. Studies are also limited by small sample sizes [92,112,122,143,[162][163][164][165], short durations [92,112,122,143,162,165], and mixed analysis of pre-diabetic and diabetic patients [92,122], highlighting the need for large long-term randomized control trials.…”