Outcome of Cystic Fibrosis-Related Diabetes Two Years after Lung Transplantation

Abstract

Background: Although transplantation is known to impair glucose tolerance, evolution of pre-existing diabetes after lung transplantation (LT) in cystic fibrosis (CF) has never been described. Objectives: We aimed to assess the outcome of CF-related diabetes (CFRD) after LT, with the hypothesis that suppressing chronic inflammatory foci may improve glucose tolerance in some patients. Methods: In a retrospective study of 29 CF diabetic patients treated with insulin and undergoing LT, CFRD control was assessed 3 months before LT and 1 (n = 27) and 2 (n = 18) years after LT by measuring insulin dosage, fasting blood glucose and glycosylated hemoglobin (HbA1c) levels. Patients with HbA1c ≤7% and an insulin dose ≤1 UI/kg/day were defined as having controlled CFRD (group A). Other patients were assigned to group B. Results: Before LT, 19 (65.5%) patients were in group A. At 2 years, 6 of 10 (60%) patients who were in group B prior to LT had moved into group A, which then comprised 77.8% of all patients. Insulin could have been stopped in 5 patients. Uncontrolled CFRD before LT (OR = 16) and a long delay between the diagnosis of CFRD and LT (OR = 1.3) were significant predictors of uncontrolled CFRD at 1 year. Conclusions: LT does not seem to worsen CFRD in some patients, suggesting that in some cases, glucose tolerance may be improved by the suppression of chronic pulmonary infection.

Glucose Tolerance in Patients with Cystic Fibrosis – Results from the German Cystic Fibrosis Registry

“…However, it further indicates that F508del is associated with elevated 1-h glucose values and that also males are affected by pre-diabetic conditions, mainly IFG. As expected, any transplantation, nutritional supplementation, and/or steroid use were related to increased rates of glucose tolerance abnormalities due to the effect of anti-inflammatory/immunosuppressive medication on postprandial insulin sensitivity [22,26] or the potential contribution of enteral/parenteral nutrition to postprandial hyperglycemia.…”

Cystic fibrosis related diabetes—a new perspective on the optimal management of postprandial glycemia

“…Lung transplantation does not appear to increase the risk of diabetes in CF patients compared with non-CF transplant patients [25]; however glycaemic control deteriorates in the majority of CFRD patients following transplantation [26].…”

Long‐term extrapulmonary comorbidities after lung transplantation in cystic fibrosis: Update of specificities

“…Valour et al published a retrospective study investigating the course of pre‐existing CFRD after LT and found better control of CFRD in two‐thirds of patients. They proposed that the improvement of insulin sensitivity was related to the reduction in systemic inflammation related to chronic pulmonary infection . In some studies, pre‐existing CFRD or development after LT did not appear to be associated with worse outcomes; Hofer et al even found a trend toward better survival after LT in patients with CFRD.…”

“…They proposed that the improvement of insulin sensitivity was related to the reduction in systemic inflammation related to chronic pulmonary infection. 23 In some studies, pre-existing CFRD or development after LT did not appear to be associated with worse outcomes 18,24 ; Hofer et al 25 even found a trend toward better survival after LT in patients with CFRD. However, in several studies, the mortality in patients with CF appears higher among those with CFRD diagnosed before LT compared to those without.…”