Glucose intolerance in cystic fibrosis as a determinant of pulmonary function and clinical status. Issue 3 (December 2015)

• Record Type: Journal Article
• Authors: Lavie, Moran; Fisher, Dor; Vilozni, Daphna; Forschmidt, Rinat; Sarouk, Ifat; Kanety, Hannah; Hemi, Rina; Efrati, Ori; Modan-Moses, Dalit
• Is Part Of: Diabetes research and clinical practice. Volume 110:Issue 3(2015)
• Page Start: 276
• Page End: 284
• Publication Date: 2015-12
• Subjects: Cystic fibrosis -- Impaired glucose tolerance (IGT) -- Cystic fibrosis related diabetes (CFRD) -- Insulin resistance -- Adiponectin; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2015.10.007
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: CFRD is associated with clinical deterioration. We investigated the significance of impaired glucose tolerance (IGT) in CF. Patients with IGT had impaired β-cell function and normal insulin sensitivity. Patients with IGT had lower BMI-SDS, FEV1 and albumin and higher fibrinogen. IGT in CF patients is associated with clinical deterioration. Abstract: Background: Cystic fibrosis related diabetes (CFRD) is associated with a decrease in pulmonary function and nutritional status. We investigated the clinical significance of impaired glucose tolerance (IGT) in cystic fibrosis (CF) patients. Methods: Fifty-five CF patients (aged 22.8 ± 9.2 years, 29 males, mean FEV1 67.9 ± 22% predicted, mean BMI-SDS −0.23 ± 1.1) underwent a 2-h Oral Glucose Tolerance Test (OGTT) with 30-min interval measurements of glucose and insulin. Additional clinical and laboratory data were obtained from the medical charts. Results: Thirty-eight participants (69%) had normal glucose tolerance (NGT), 13 (23.7%) had IGT, and 4 (7.3%) had newly diagnosed CFRD. Compared to patients with NGT, patients with IGT had significantly lower BMI-SDS (−1.1 ± 0.8 vs. 0.1 ± 1.1, p < 0.001), mean FEV1 (57 ± 19 vs. 74 ± 21% predicted, p < 0.01), and albumin (3.9 ± 0.3 vs. 4.3 ± 0.2 g/dl, p = 0.004), and higher fibrinogen (376 ± 56 vs. 327 ± 48 g/dl, p = 0.02). Patients with IGT had impaired β-cell function, with reduced first phase insulin secretion, a delayed insulin peak, and significantly lower total insulin secretion, HOMA-%B and insulinogenic index. Seven patients had HbA1c in the "diabetic" range (≥6.5%; 47.5 mmol/mol), however, HbA1c was not a sensitive or specific marker of glucose tolerance status. Conclusions: IGT in CF patients is associated with increased inflammation and decreased nutritional status and pulmonary function.