OC44 Optimization of diagnostics for carbohydrate mechanism disorder in children with cystic fibrosis. (June 2019)

• Record Type: Journal Article
• Authors: Matveyeva, Tatiyana; Orlov, Aleksandr; Tkach, Marina; Zhelenina, Liudmila; Kuropatenko, Mariya; Ditkovskaya, Liliya
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 3
• Page Start: A18
• Page End: A19
• Publication Date: 2019-06
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-epa.42
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aim: T o study the incidence and optimize diagnostics of carbohydrate mechanism disorder in children with cystic fibrosis (CF). Materials and methods: We have examined 43 patients with cystic fibrosis. All the patients were subject to the following tests: blood chemistry, HbA1c, insulin, C-peptide EIA assay, antibodies to ICA, IAA, GAD in order to rule out other forms of diabetes mellitus, oral glucose tolerance test (GTT). Carbohydrate mechanism disorders were diagnosed according to the WHO criteria (ISPAD 2018). In order to assess tissue sensitivity to insulin, Homa and Caro indices were calculated during the study. Additionally, 31 patients (including 15 children aged 3–11, others were adolescents) underwent Continuous Glucose Monitoring System (CGMS) test with the help of MiniMed Paradigm 722. All the children were given a molecular genetic test in order to detect various GFTR mutations. Results: The oral glucose tolerance test revealed carbohydrate metabolism disorders in 28% of the case, CF-associated diabetes mellitus was diagnosed in 19% of the case. Impaired glucose tolerance was diagnosed in 9% patients. Carbohydrate metabolism disorders among adolescents were distributed as follows: impaired glucose tolerance (19%) and CF-associated diabetes mellitus (43%). Calculated indices of insulin resistance (Homa and Caro) showed that 71% of patients with carbohydrate metabolism disorders had a decrease in Caro (<0, 332) on the 120 th minute of the oral glucose tolerance test, which indicated insulin resistance. The average HbA1c levels in children with CF-associated diabetes mellitus were 7, 3±3, 4%, children with glucose tolerance – 6, 3±0, 4% and in children with normal carbohydrate metabolism – 5, 8±0, 3%. The CGMS assessment detected hyperglycemia in 81% patients, while carbohydrate metabolism disorders were diagnosed only in 28% of the cases. Stable postprandial hyperglycemia was detected with CGMS in 91% children aged ≥11 and 64% in group 3–11. The 74, 4% patients had delF508 mutations (homozygous-32%). All the cases of CF-associated diabetes mellitus were diagnosed in these patients. Conclusions: The incidence of carbohydrate metabolism disorders in CF-children was reliably higher than in overall population (28%). Carbohydrate metabolism disorders and CF-associated diabetes were reliably more frequent in children over 11 years of age. Insulin resistance must be the most likely cause of carbohydrate metabolism disorders. CGMS in patients with cystic fibrosis helps to detect hidden hyperglycemia that cannot be detected with the help of standard methods. Carbohydrate metabolism disorders and CF-associated diabetes mellitus are more frequent in patients with delF508 mutation.