Trajectories of oral glucose tolerance testing in cystic fibrosis

Abstract

Introduction Annual oral glucose tolerance testing (OGTT) is the recommended screening modality for cystic fibrosis‐related diabetes (CFRD) in patients with cystic fibrosis (CF). This study aimed to determine if there were patterns of progression of worsening glucose homeostasis in pediatric CF patients and to explore any relationship to lung function. Methods We conducted a retrospective cohort study of CF patients, ages 10–18 years, without CFRD and with ≥3 OGTT from 2013 to 2016. Latent class mixture models were used to determine unique trajectories of 2‐h OGTT glucose values (2hrGlu) over time. Multivariable linear models were used to adjust for clinical covariates. Results For 63 subjects, three unique 2hrGlu trajectories were identified: high (impaired glucose tolerance) to higher (n = 8), low (normal glucose tolerance [NGT]) and increasing (n = 47), and low (NGT) and flat (n = 8). There was high variability of 2hrGlu, but most patients belonged to a trajectory that increased over time. After controlling for age, pancreatic insufficiency, modulator use, and mutation type, there was a significant difference in the study baseline forced expiratory volume in 1 s percent predicted (ppFEV1) in the high to higher group compared to the low and increasing and low and flat groups (p < .005). Discussion Among pediatric CF patients without diabetes, three 2hrGlu trajectories were identified with 87% of patients exhibiting a trajectory where glucose homeostasis worsened over time. Starting ppFEV1 was lower in those with a high to higher trajectory, supporting that lower lung function is present early in the development of CFRD.

An Update in Cystic Fibrosis-Related Diabetes in Children and Adolescents

“…The onset of CFRD is accompanied by an exacerbation of the deterioration of the nutritional status and pulmonary functions attributed to insulin deficiency and recurrent lung disease exacerbations, resulting in an increased number of hospitalizations, a higher prevalence of infections from P. aeruginosa and Burkholderia cepacia, and diminished overall physical health. Moreover, several studies have demonstrated that clinical deteriorations can initiate up to 4-5 years before a formal diagnosis of diabetes is made, as indicated by Patel et al in 2021 [58]. CFRD is associated with reduced life expectancy and elevated mortality and morbidity rates, with no observable gender-based disparities in mortality, according to the findings of Ballmann (2021) and Suppakitjanusant et al (2023) [6,59].…”

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

“…Традиционно принято считать, что снижение нутритивного статуса (НС) и ухудшение функции легких приводят к МЗСД, что является причиной ранней смертности и ухудшает качество жизни пациентов [4][5][6][7]. До 30 лет доживают менее 25% пациентов с МЗСД по сравнению с 60% пациентов с МВ без НУО [8,9]. С возрастом распространенность МЗСД возрастает: у 2-5% детей до 10 лет, у 20% подростков и 40-50% взрослых с МВ развивается МЗСД [10][11][12][13].…”