Spontaneous and iatrogenic hypoglycemia in cystic fibrosis

Hicks, Rebecca; Marks, Brynn E.; Oxman, Rachael; Moheet, Amir

doi:10.1016/j.jcte.2021.100267

Cited by 7 publications

(7 citation statements)

References 59 publications

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“…Furthermore, as there are no established guidelines to define an abnormal CGM, we used published thresholds to define “abnormal” CGM and assess reproducibility. Additionally, as a fully at-home study we relied on the participant to fast on the MMTT day, record the time of Boost ingestion, and ensure no other food or drink for at least 3 h. Use of the MMTT, without the gold-standard OGTT, was performed due to high rates of hypoglycemia with the OGTT and safety concerns about performing OGTTs in the home environment, but is a limitation [25] . As there are no established thresholds for abnormal glycemic response to MMTT, we chose >140 mg/dL, >180 mg/dL, and >200 mg/dL, but these are not expected to correlate with the gold-standard OGTT due to lower glycemic load of the mixed meal test.…”

Section: Resultsmentioning

confidence: 99%

Reproducibility of in-home CFRD screening using continuous glucose monitoring and mixed meal tolerance test

Kutney,

Kaminski,

Casey

et al. 2023

Journal of Clinical & Translational Endocrinology

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Section: Resultsmentioning

confidence: 99%

Reproducibility of in-home CFRD screening using continuous glucose monitoring and mixed meal tolerance test

Kutney,

Kaminski,

Casey

et al. 2023

Journal of Clinical & Translational Endocrinology

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Section: Results: Potential Uses Of Cgm By People Without Diabetesmentioning

confidence: 99%

“…36 CGMs are also being used in selected outpatients with diabetes who are not using insulin 4 as well as people with cystic fibrosis-related diabetes 37 and cystic fibrosis-related hypoglycemia. 38 CGMs have been used to achieve tight glycemic control in critically ill hospitalized patients with secondary diabetes 39,40 or stress hyperglycemia in adults 41 and children. 42 This type of practice is currently investigational and requires protocols specifying sensor glucose and point of care glucose measurements for sensor validation as well as highly trained staff members and appropriate hospital policies.…”

Section: Metabolic Diseasementioning

confidence: 99%

Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come?

Klonoff

Nguyen

et al. 2022

J Diabetes Sci Technol

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Background: Continuous glucose monitor (CGM) systems were originally intended only for people with diabetes. Recently, there has been interest in monitoring glucose concentrations in a variety of other situations. As data accumulate to support the use of CGM systems in additional states unrelated to diabetes, the use of CGM systems is likely to increase accordingly. Methods: PubMed and Google Scholar were searched for articles about the use of CGM in individuals without diabetes. Relevant articles that included sufficient details were queried to identify what cohorts of individuals were adopting CGM use and to define trends of use. Results: Four clinical user cases were identified: (1) metabolic diseases related to diabetes with a primary dysregulation of the insulin-glucose axis, (2) metabolic diseases without a primary pathophysiologic derangement of the insulin-glucose axis, (3) health and wellness, and (4) elite athletics. Seven trends in the use of CGM systems in people without diabetes were idenfitied which pertained to both FDA-cleared medical grade products as well as anticipated future products, which may be regulated differently based on intended populations and indications for use. Conclusions: Wearing a CGM has been used not only for diabetes, but with a goal of improving glucose patterns to avoid diabetes, improving mental or physical performance, and promoting motivate healthy behavioral changes. We expect that clinicians will become increasingly aware of (1) glycemic patterns from CGM tracings that predict an increased risk of diabetes, (2) specific metabolic glucotypes from CGM tracings that predict an increased risk of diabetes, and (3) new genetic and genomic biomarkers in the future.

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“…The “inflammation hypothesis” suggests that initial structural damage to β cells is accompanied with an exaggerated inflammatory response adding further insult, 24 which may explain insulin resistance seen in cystic fibrosis. Disruption of the incretin 25 axis that regulates release of insulin and glucagon from the pancreatic islet cells, lipid metabolism, gut motility, appetite, body weight, and immune function has also been postulated.…”

Section: Cystic Fibrosis‐related Diabetesmentioning

confidence: 99%

Effects of modulator therapies on endocrine complications in adults with cystic fibrosis: a narrative review

Kumar,

Soldatos,

Teede

et al. 2023

Medical Journal of Australia

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Summary Cystic fibrosis is a monogenic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which transports chloride ions in secretory organs. Modulator therapies are small molecules that correct CFTR dysfunction and can lead to a wide range of benefits for both pulmonary and extrapulmonary complications of cystic fibrosis. With advancements in airway, antimicrobial and nutritional therapies and now introduction of modulator therapies, most people living with cystic fibrosis in Australia are now adults. For adults with cystic fibrosis, endocrine manifestations such as cystic fibrosis‐related diabetes, metabolic bone disease, and reproductive health are becoming increasingly important, and emerging evidence on the endocrine effects of CFTR modulator therapies is promising and is shifting paradigms in our understanding and management of these conditions. The management of cystic fibrosis‐related diabetes will likely need to pivot for high responders to modulator therapy with dietary adaptions and potential use of medications traditionally reserved for adults with type 2 diabetes, but evidence to support changing clinical care needs is currently lacking. Increased attention to diabetes‐related complications screening will also be required. Increased exercise capacity due to improved lung function, nutrition and potentially direct modulator effect may have a positive impact on cystic fibrosis‐related bone disease, but supporting evidence to date is limited. Fertility can improve in women with cystic fibrosis taking modulator therapy. This has important implications for pregnancy and lactation, but evidence is lacking to guide pre‐conception and antenatal management. Provision of multidisciplinary clinical care remains ever‐important to ensure the emergence of endocrine and metabolic complications are optimised in adults with cystic fibrosis.

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Spontaneous and iatrogenic hypoglycemia in cystic fibrosis

Cited by 7 publications

References 59 publications

Reproducibility of in-home CFRD screening using continuous glucose monitoring and mixed meal tolerance test

Reproducibility of in-home CFRD screening using continuous glucose monitoring and mixed meal tolerance test

Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come?

Effects of modulator therapies on endocrine complications in adults with cystic fibrosis: a narrative review

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