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Bolduc MÈ, Potter KJ, Olmos M, Bonhoure A, Coriati A, Alexandre-Heymann L, Tremblay F, Lavoie A, Carricart M, Senior PA, Boudreau V, Rabasa-Lhoret R. Cystic fibrosis-related diabetes develops from a combination of insulin secretion defects and insulin resistance. Diabetes Obes Metab 2024; 26:4744-4752. [PMID: 39118592 DOI: 10.1111/dom.15844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
AIM The relative contributions of insulin secretory defects and possible additional contribution of insulin resistance for the development of cystic fibrosis (CF)-related diabetes (CFRD) are poorly understood. We aimed to (a) determine which indices of insulin resistance predict progression to CFRD, and (b) to model the relative contributions of insulin secretory function and insulin resistance to predict the risk of CFRD. MATERIALS AND METHODS Three hundred and three individuals living with CF underwent a 2-h oral glucose tolerance test with blood sampling every 30 min at 12-24-month intervals until they developed CFRD or until the end of follow-up (up to 15 years). Indices of insulin resistance (e.g. Stumvoll) and insulin secretion were calculated from oral glucose tolerance test glucose and insulin measurements. CFRD-free survival was assessed by survival analysis. RESULTS Estimated insulin resistance showed associations with glucose homeostasis and risk of progression to CFRD. The CFRD-free survival was significantly different between quartiles of insulin resistance (p < 0.0001). When patients were subdivided according to both insulin resistance and insulin secretion (insulinogenic index), CFRD-free survival was significantly lower in those with combined lowest insulin secretion and highest insulin resistance (Stumvoll) indices (hazard ratio: 11.2; p < 0.0001). There was no significant difference when the same analysis was performed for the nine other indices. CONCLUSIONS Insulin resistance is correlated with glucose homeostasis and the risk of progression to CFRD. Patients combining low insulin secretion and high insulin resistance had the greatest odds of developing CFRD over a 15-year period.
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Affiliation(s)
- Marie-Ève Bolduc
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Kathryn J Potter
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Maxime Olmos
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Anne Bonhoure
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Adèle Coriati
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre of Hôpital du Sacré-Cœur de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | | | - François Tremblay
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Annick Lavoie
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Maité Carricart
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Peter A Senior
- Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Valérie Boudreau
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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2
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Wilschanski M, Munck A, Carrion E, Cipolli M, Collins S, Colombo C, Declercq D, Hatziagorou E, Hulst J, Kalnins D, Katsagoni CN, Mainz JG, Ribes-Koninckx C, Smith C, Smith T, Van Biervliet S, Chourdakis M. ESPEN-ESPGHAN-ECFS guideline on nutrition care for cystic fibrosis. Clin Nutr 2024; 43:413-445. [PMID: 38169175 DOI: 10.1016/j.clnu.2023.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with CF were published in 2016. An update to these guidelines is presented. METHODS The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members. RESULTS The Working Group updated the nutritional guidelines including assessment and management at all ages. Supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.
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Affiliation(s)
- Michael Wilschanski
- Pediatric Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Anne Munck
- Cystic Fibrosis Centre, Hopital Necker-Enfants Malades, AP-HP, Paris, France
| | - Estefania Carrion
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Marco Cipolli
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sarah Collins
- CF Therapies Team, Royal Brompton & Harefield Hospital, London, UK
| | - Carla Colombo
- University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dimitri Declercq
- Cystic Fibrosis Reference Centre, Ghent University Hospital and Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Elpis Hatziagorou
- Cystic Fibrosis Unit, 3rd Pediatric Dept, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Jessie Hulst
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics and Department of Nutritional Sciences, The University of Toronto, Toronto, Canada
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada
| | - Christina N Katsagoni
- Department of Clinical Nutrition, Agia Sofia Children's Hospital, Athens, Greece; EFAD, European Specialist Dietetic Networks (ESDN) for Gastroenterology, Denmark
| | - Jochen G Mainz
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology and Paediatric Cystic Fibrosis Unit. La Fe Hospital & La Fe Research Institute, Valencia, Spain
| | - Chris Smith
- Department of Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Thomas Smith
- Independent Patient Consultant Working at Above-disease Level, UK
| | | | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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3
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Kocaaga E, Inal-Ince D, Dogru D, Alikasifoglu A, Ademhan-Tural D, Bozdemir-Ozel C, Calik-Kutukcu E, Saglam M, Vardar-Yagli N, Emiralioglu N. Exercise performance in children and adolescents with cystic fibrosis with and without abnormal glucose tolerance: a single center cross-sectional study. Physiother Theory Pract 2024; 40:230-240. [PMID: 36043898 DOI: 10.1080/09593985.2022.2116300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Abnormal glucose tolerance (AGT) in cystic fibrosis (CF) affects lung function and clinical parameters, including aerobic fitness. However, its effects on physical activity level (PAL), anaerobic power (AP), and muscle strength (MS) in children and adolescents are unknown. PURPOSE To investigate aerobic fitness, PAL, AP, and MS in pediatric patients with mild-to-moderate CF and AGT. METHODS The study included children and adolescents with CF aged 10-18 years. Participants underwent a pulmonary function test, quadriceps, and handgrip MS measurement, vertical jump test to assess AP, and six-minute walk test (6MWT) to assess aerobic fitness. Bouchard's Three-Day Physical Activity record was used to determine PAL. RESULTS Height z-score (p = .006), 6MWT (p = .024), handgrip (p = .028), quadriceps MS (p = .044), and AP (p = .036) were significantly lower in AGT (n = 21) than normal glucose tolerance (NGT) (n = 19). In the AGT group, glycosylated hemoglobin (HbA1c) was significantly associated with forced expiratory volume in one second (FEV1) (p = .046). 6MWT distance (6MWD) was associated with height (p = .008), FEV1 (p = .001), forced vital capacity (FVC) (p = .001), forced expiratory flow from 25% to 75% (FEF25-75%) (p = .030), handgrip MS (p = .012), and PAL (p = .034). After adjusting for height and FEV1, the groups had similar 6MWD, MS, and AP (p > .05); also, insulin was associated with MS and AP but not with 6MWT or quadriceps MS. CONCLUSION Measures of aerobic fitness, MS, and AP are lower in AGT, but after adjusting for height and FEV1, aerobic fitness, MS, and AP do not show substantial differences. Insulin sensitivity and resistance are associated with MS and AP.
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Affiliation(s)
- Elif Kocaaga
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Deniz Dogru
- Faculty of Medicine, Department of Pediatric Chest Medicine, Sihhiye Campus, Hacettepe University, Ankara, Turkey
| | - Ayfer Alikasifoglu
- Faculty of Medicine, Department of Pediatric Endocrinology, Sihhiye Campus, Hacettepe University, Ankara, Turkey
| | - Dilber Ademhan-Tural
- Faculty of Medicine, Department of Pediatric Chest Medicine, Sihhiye Campus, Hacettepe University, Ankara, Turkey
| | - Cemile Bozdemir-Ozel
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Meselik Campus, Eskisehir Osman Gazi University, Odunpazarı, Eskisehir, Turkey
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Sihhiye Campus, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Nagehan Emiralioglu
- Faculty of Medicine, Department of Pediatric Chest Medicine, Sihhiye Campus, Hacettepe University, Ankara, Turkey
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4
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Potter KJ, Boudreau V, Bonhoure A, Tremblay F, Lavoie A, Carricart M, Senior PA, Rabasa-Lhoret R. Insulinogenic index and early phase insulin secretion predict increased risk of worsening glucose tolerance and of cystic fibrosis-related diabetes. J Cyst Fibros 2023; 22:50-58. [PMID: 36028423 DOI: 10.1016/j.jcf.2022.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Measures of stimulated insulin secretion are emerging as important predictors of diabetes mellitus in at-risk populations. We analyzed the utility of clinical estimates of insulin secretion in a prospective cohort at risk for cystic fibrosis-related diabetes (CFRD). METHODS We divided the profiles of 189 people with CF (pwCF) followed longitudinally in the Montreal CF cohort (mean follow up 6.6 ± 1.2 years) according to quartiles of the insulinogenic index (IGI; (I30-I0)/(G30-G0)); area under the curve for insulin normalized for glucose (AUCins/glu), and HOMA-B at baseline to compare clinical characteristics and risk of CFRD according to quartiles for each measure. We also compared characteristics of 40 pwCF found to have de novo CFRD at baseline. RESULTS At baseline, IGI and AUCins/glu were lower in subjects with de novo CFRD and those who later developed CFRD than those who never developed CFRD (p < 0.0001 for each). Subjects with the lowest quartiles of IGI, AUCins/glu, and AUCins/glu 0-30 had increased risk of developing CFRD by Kaplan-Meier analysis (p = 0.0244, p = 0.0024, and p = 0.0338, respectively). There was no significant difference in risk between quartiles of HOMA-B. Subjects in the lowest quartile of IGI showed a significant increase in 2-hour OGTT glucose and AUCglu between the initial and final study visits (p = 0.0027 and p = 0.0044, respectively). CONCLUSION IGI is easily measured in a clinical setting and needs to be validated in prospective studies as a potential tool to improve risk stratification in CFRD with direct relevance to pathogenesis.
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Affiliation(s)
- Kathryn J Potter
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - Valérie Boudreau
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Anne Bonhoure
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada
| | - François Tremblay
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Annick Lavoie
- Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Maité Carricart
- Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Peter A Senior
- Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Division of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
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5
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Potter KJ, Bonhoure A, Boudreau V, Tremblay F, Lavoie A, Carricart M, Senior PA, Rabasa-Lhoret R. Marginal association of fasting blood glucose with the risk of cystic fibrosis-related diabetes. ANNALES D'ENDOCRINOLOGIE 2022; 84:265-271. [PMID: 36332698 DOI: 10.1016/j.ando.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Cystic fibrosis-related diabetes (CFRD) may be diagnosed by fasting blood glucose ≥ 7.0 mmol/L and/or glucose ≥ 11.1 mmol/L following oral glucose tolerance test (OGTT). We compared the role of fasting and stimulated glucose for diagnosis of CFRD. METHODS We performed a cross-sectional review of the prevalence of fasting glycemic abnormalities and Kaplan-Meier survival analysis of risk of progression to CFRD according to baseline fasting glucose in the prospective Montreal Cystic Fibrosis Cohort. RESULTS Isolated fasting hyperglycemia was detected in only 8% of participants at study onset. Eighty percent of subjects had isolated post-challenge hyperglycemia on their first OGTT meeting criteria for CFRD. Kaplan Meier survival analysis demonstrated that impaired fasting glucose (IFG) alone is not a risk factor for CFRD. Subjects with combined IFG and impaired glucose tolerance at baseline (IGT) had the highest risk of progression to CFRD. CONCLUSION Post-prandial elevations in blood glucose are more common at diagnosis of CFRD. While IGT is a significant risk factor for CFRD, IFG alone is uncommon and does not increase the risk of CFRD. Patients with both IGT and IFG have the highest risk of CFRD.
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Affiliation(s)
- Kathryn J Potter
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Bonhoure
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Division of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Valérie Boudreau
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - François Tremblay
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Annick Lavoie
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Maité Carricart
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Peter A Senior
- Department of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Division of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
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6
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Rakotoarisoa L, Wagner C, Munch M, Renaud Picard B, Grenet D, Olland A, Greget M, Enescu I, Bouilloud F, Bonnette P, Guth A, Bosco D, Mercier C, Rabilloud M, Berney T, Yves Benhamou P, Massard G, Camilo C, Colin C, Arnold C, Kessler R, Kessler L. Feasibility and efficacy of combined pancreatic islet-lung transplantation in cystic fibrosis-related diabetes-PIM study: A multicenter phase 1-2 trial. Am J Transplant 2022; 22:1861-1872. [PMID: 35403818 PMCID: PMC9540675 DOI: 10.1111/ajt.17058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 01/25/2023]
Abstract
Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis (CF), and restoring metabolic control in these patients may improve their management after lung transplantation. In this multicenter, prospective, phase 1-2 trial, we evaluate the feasibility and metabolic efficacy of combined pancreatic islet-lung transplantation from a single donor in patients with CFRD, terminal respiratory failure, and poorly controlled diabetes. Islets were infused via the portal vein under local anesthesia, 1 week after lung transplantation. At 1 year, the primary outcome was transplant success as evaluated by a composite score including four parameters (weight, fasting glycemia, HbA1c, and insulin requirements). Ten participants (age: 24 years [17-31], diabetes duration: 8 years [4-12]) received a combined islet-lung transplant with 2892 IEQ/kg [2293-6185]. Transplant success was achieved in 7 out of 10 participants at 1-year post transplant. Fasting plasma C-peptide increased from 0.91 μg/L [0.56-1.29] to 1.15 μg/L [0.77-2.2], HbA1c decreased from 7.8% [6.5-8.3] (62 mmol/mol [48-67]) to 6.7% [5.5-8.0] (50 mmol/mol [37-64]), with 38% decrease in daily insulin doses. No complications related to the islet injection procedure were reported. In this pilot study, combined pancreatic islet-lung transplantation restored satisfactory metabolic control and pulmonary function in patients with CF, without increasing the morbidity of lung transplantation.
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Affiliation(s)
- Luc Rakotoarisoa
- Department of Endocrinology, Diabetes and NutritionStrasbourg University HospitalFrance,Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance
| | - Clothilde Wagner
- Department of Endocrinology, Diabetes and NutritionStrasbourg University HospitalFrance
| | - Marion Munch
- Department of Endocrinology, Diabetes and NutritionStrasbourg University HospitalFrance
| | - Benjamin Renaud Picard
- Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance,Department of PneumologyCystic Fibrosis CenterStrasbourg UniversityStrasbourgFrance
| | - Dominique Grenet
- Department of PneumologyCystic Fibrosis CenterHôpital FochSuresnesFrance
| | - Anne Olland
- Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance,Department of Thoracic SurgeryStrasbourg University HospitalStrasbourgFrance
| | - Michel Greget
- Department of RadiologyStrasbourg University HospitalStrasbourgFrance
| | - Iulian Enescu
- Department of RadiologyStrasbourg University HospitalStrasbourgFrance
| | | | | | - Axel Guth
- Department of RadiologyHôpital FochSuresnesFrance
| | - Domenico Bosco
- Department of Surgery, Islet Isolation, and TransplantationGeneva University HospitalsGenevaSwitzerland
| | - Catherine Mercier
- Pôle Santé PubliqueService de Biostatistique et BioinformatiqueHospices Civils de Lyon, LyonFrance,Université de LyonLyonFrance,Université Lyon 1VilleurbanneFrance,Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐SantéCNRSUMR 5558VilleurbanneFrance
| | - Muriel Rabilloud
- Pôle Santé PubliqueService de Biostatistique et BioinformatiqueHospices Civils de Lyon, LyonFrance,Université de LyonLyonFrance,Université Lyon 1VilleurbanneFrance,Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐SantéCNRSUMR 5558VilleurbanneFrance
| | - Thierry Berney
- Department of Surgery, Islet Isolation, and TransplantationGeneva University HospitalsGenevaSwitzerland
| | - Pierre Yves Benhamou
- Department of Endocrinology, Diabetes and NutritionGrenoble University HospitalGrenobleFrance
| | - Gilbert Massard
- Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance,Department of Thoracic SurgeryStrasbourg University HospitalStrasbourgFrance
| | - Coralie Camilo
- Pôle Santé PubliqueService de Biostatistique et BioinformatiqueHospices Civils de Lyon, LyonFrance,Université de LyonLyonFrance,Université Lyon 1VilleurbanneFrance,Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐SantéCNRSUMR 5558VilleurbanneFrance
| | - Cyrille Colin
- Pôle Santé PubliqueService de Biostatistique et BioinformatiqueHospices Civils de Lyon, LyonFrance,Université de LyonLyonFrance,Université Lyon 1VilleurbanneFrance,Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐SantéCNRSUMR 5558VilleurbanneFrance
| | - Cécile Arnold
- Department of Clinical ResearchStrasbourg University HospitalStrasbourgFrance
| | - Romain Kessler
- Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance,Department of PneumologyCystic Fibrosis CenterStrasbourg UniversityStrasbourgFrance
| | - Laurence Kessler
- Department of Endocrinology, Diabetes and NutritionStrasbourg University HospitalFrance,Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance
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7
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Potter KJ, Reynaud Q, Boudreau V, Racine F, Tremblay F, Lavoie A, Carricart M, Mailhot G, Durieu I, Senior PA, Rabasa-Lhoret R. Combined Indeterminate and Impaired Glucose Tolerance Is a Novel Group at High Risk of Cystic Fibrosis-Related Diabetes. J Clin Endocrinol Metab 2021; 106:e3901-e3910. [PMID: 34132785 DOI: 10.1210/clinem/dgab384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Indeterminate glycemia (INDET) and impaired glucose tolerance (IGT) are independently associated with cystic fibrosis-related diabetes (CFRD) risk. We determined whether patients meeting both criteria have increased risk of diabetes in 2 separate adult cohorts. METHODS The Montreal Cystic Fibrosis Cohort (MCFC; n = 293 baseline and 198 for prospective analysis excluding subjects identified with incident CFRD at baseline) and the Lyon cystic fibrosis cohort [Determination of the Predictive Factors in the Reversibility or the Aggravation in the Disorders of the Glucose Metabolism in Cystic Fibrosis Patients (DIAMUCO); n = 144/105] are prospective observational cohorts. RESULTS In the MCFC and DIAMUCO cohorts, mean age was 25.5 ± 7.7 and 25.0 ± 8.6 years; body mass index, 21.7 ± 3.0 and 20.2 ± 2.2 kg/m2; percentage of forced expiratory volume expired in 1 sec, 73.2 ± 22.1 and 62.5 ± 21.9; and follow-up, 6.9 ± 3.8 and 2.4 ± 1.2 years, respectively. In the MCFC cohort, the IGT only and combined INDET and IGT (INDET + IGT) groups had greater risk of CFRD (P = 0.0109). In the DIAMUCO cohort, there was lower diabetes-free survival in the INDET + IGT group (P = 0.0105). In both cohorts, CFRD risk ranged from 17% in normal glucose tolerance patients up to 42% to 56% in patients with INDET + IGT. CONCLUSION Patients who meet combined criteria have a higher risk of developing diabetes probably justifying closer follow-up.
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Affiliation(s)
| | - Quitterie Reynaud
- Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France
- Department of internal medicine, Université de Lyon, Lyon, France
| | - Valérie Boudreau
- Montreal Clinical Research Institute, Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Florence Racine
- Montreal Clinical Research Institute, Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - François Tremblay
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Annick Lavoie
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Maite Carricart
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Geneviève Mailhot
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Isabelle Durieu
- Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France
- Department of internal medicine, Université de Lyon, Lyon, France
| | - Peter A Senior
- Department of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Department of Endocrinology, Faculty of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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8
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Rosanio FM, Mozzillo E, Cimbalo C, Casertano A, Sepe A, Raia V, Franzese A, Tosco A. Diabetes outbreak during COVID19 lock-down in a prediabetic patient with cystic fibrosis long treated with glargine. Ital J Pediatr 2021; 47:121. [PMID: 34078438 PMCID: PMC8170445 DOI: 10.1186/s13052-021-01076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cystic Fibrosis Related Diabetes (CFRD) is a frequent comorbidity of patients with Cystic Fibrosis (CF). A worsening of clinical conditions appears before CFRD. It has been demonstrated a decline in pulmonary function and nutritional status also in patients with prediabetes. Few trials show that insulin may be beneficial in prediabetic CF patients, to date guidelines do not recommend for this condition. CASE PRESENTATION We report a case of a patient treated with insulin glargine at 13 years, due to glycemic intolerance, and with Lumacaftor/Ivacaftor at 15 years. A reduction of pulmonary exacerbations was observed after glargine therapy, also confirmed after the starting of Lumacaftor/ Ivacaftor in this patient. Pulmonary function improved only after the first year of glargine therapy, then a deterioration appeared due to the natural history of CF lung damage. During the COVID-19 lockdown, poor adherence to care contributed to diabetes mellitus onset needing high insulin requirements. After two weeks the patient returned to prediabetic condition and his previous dose of glargine. CONCLUSIONS our case highlights firstly that insulin glargine has contributed to preserve him from further clinical worsening due to prediabetes in the years before pandemic, secondly the negative impact of COVID-19 lockdown on the clinical course of a chronic disease as CF.
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Affiliation(s)
- Francesco Maria Rosanio
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy.
| | - Chiara Cimbalo
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Alberto Casertano
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Angela Sepe
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Valeria Raia
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Adriana Franzese
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Antonella Tosco
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
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9
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Izsák VD, Soós A, Szakács Z, Hegyi P, Juhász MF, Varannai O, Martonosi ÁR, Földi M, Kozma A, Vajda Z, Shaw JAM, Párniczky A. Screening Methods for Diagnosing Cystic Fibrosis-Related Diabetes: A Network Meta-Analysis of Diagnostic Accuracy Studies. Biomolecules 2021; 11:520. [PMID: 33807165 PMCID: PMC8065857 DOI: 10.3390/biom11040520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cystic fibrosis-related diabetes (CFRD) has become more common due to higher life expectancy with cystic fibrosis. Early recognition and prompt treatment of CFRD leads to improved outcomes. METHODS We performed a network meta-analysis (NMA) in order to identify the most valuable diagnostic metrics for diagnosing CFRD out of available screening tools (index test), using the oral glucose tolerance test as a reference standard. Pooled sensitivity (Se), specificity (Sp), and superiority indices were calculated and used to rank the index tests. RESULTS A total of 31 articles with 25 index tests were eligible for inclusion. Two-day, continuous glucose monitoring (CGM) ranked the highest (Se: 86% Sp: 76%), followed by glucose measurement from blood capillary samples (Se: 70%, Sp: 82%) and three-day CGM (Se: 96%, Sp: 56%). When we compared the CGM of different durations, two-day CGM performed best (Se: 88%, Sp: 80%), followed by three-day (Se: 96%, Sp: 59%) and six-day CGM (Se: 66%, Sp: 79%). CONCLUSIONS Considering its overall performance ranking, as well as the high sensitivity, two-day CGM appears to be a promising screening test for CFRD.
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Affiliation(s)
- Vera Dóra Izsák
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Alexandra Soós
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
- János Szentágothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Márk Félix Juhász
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
| | - Orsolya Varannai
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Ágnes Rita Martonosi
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Mária Földi
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Alexandra Kozma
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
| | - Zsolt Vajda
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
| | - James AM Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Andrea Párniczky
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (V.D.I.); (A.S.); (Z.S.); (P.H.); (M.F.J.); (O.V.); (Á.R.M.); (M.F.); (A.K.)
- Heim Pál National Pediatrics Institute, 1089 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
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10
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Elidottir H, Diemer S, Eklund E, Hansen CR. Abnormal glucose tolerance and lung function in children with cystic fibrosis. Comparing oral glucose tolerance test and continuous glucose monitoring. J Cyst Fibros 2021; 20:779-784. [PMID: 33478894 DOI: 10.1016/j.jcf.2021.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/19/2020] [Accepted: 01/03/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) related diabetes (CFRD) is a common complication of CF. CFRD is associated with declining lung function even before its onset. Regular screening for CFRD using oral glucose tolerance test (OGTT) is recommended. Additionally, continuous glucose monitoring (CGM) has surfaced as a possible surveillance method, but evidence for its use and concordance with OGTT has not been established. METHODS Children were prospectively recruited at CF center Lund to undergo both intermittent scan CGM (isCGM) and OGTT. Lung function was evaluated by spirometry and multiple breath washout. Demographic and clinical data were collected from the Swedish national CF registry. RESULTS 32 patients participated in the study, yielding 28 pairs of isCGMs and OGTTs. The OGTTs showed that two patients met the criteria of CFRD, seven had impaired glucose tolerance (IGT) and indeterminate glycemia (INDET) was found in eleven cases. The isCGM percent of measurements >8mmol/L and the number of peaks per day >11 mmol/L have correlations with intermediate OGTT glucose time points, but not the 2hour glucose value. Patients with abnormal glucose tolerance (AGT) had lower lung function than those with normal glucose tolerance demonstrated by both FEV1% predicted and lung clearance index (LCI). CONCLUSION Correlations can be found between isCGM and OGTT in regards to the latter's intermediate time points. LCI demonstrates as well as FEV1% of predicted, worse lung function in children and adolescents with abnormal glucose tolerance in CF.
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Affiliation(s)
- H Elidottir
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden; Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden; Children´s Medical Center. Landspitali - The National University Hospital of Iceland.
| | - S Diemer
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden; Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden
| | - E Eklund
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden; Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden
| | - C R Hansen
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden; Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden
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11
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Mozzillo E, Franceschi R, Piona C, Passanisi S, Casertano A, Pjetraj D, Maltoni G, Calcaterra V, Cauvin V, Cherubini V, D’Annunzio G, Franzese A, Frongia AP, Lombardo F, Lo Presti D, Matteoli MC, Piccinno E, Predieri B, Rabbone I, Scaramuzza AE, Toni S, Zucchini S, Maffeis C, Schiaffini R. Diabetes and Prediabetes in Children With Cystic Fibrosis: A Systematic Review of the Literature and Recommendations of the Italian Society for Pediatric Endocrinology and Diabetes (ISPED). Front Endocrinol (Lausanne) 2021; 12:673539. [PMID: 34017312 PMCID: PMC8130616 DOI: 10.3389/fendo.2021.673539] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Cystic fibrosis related diabetes (CFRD) is a comorbidity of cystic fibrosis (CF) that negatively impacts on its clinical course. Prediabetes is an important predictor of either CFRD development and unfavorable prognosis of CF in both pediatric and adult patients. International guidelines recommend insulin only in case of CFRD diagnosis. Whether early detection and treatment of prediabetes may contribute to improve the clinical course of CF is still debated. A subgroup of pediatric diabetologists of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) performed a systematic review of the literature based on predefined outcomes: impact of pre-diabetes on clinical outcomes and on the risk of developing CFRD; diagnosis of diabetes and pre-diabetes under 10 years of age; effectiveness of therapy on glycemic control, impact of therapy on pulmonary function and nutritional status. Thirty-one papers were selected for the analysis data presented in these papers were reported in tables sorted by outcomes, including comprehensive evidence grading according to the GRADE approach. Following the grading of the quality of the evidence, the entire ISPED diabetes study group achieved consensus for the Italian recommendations based on both evidence and clinical experience. We concluded that in patients with CF, prediabetes should be carefully considered as it can evolve into CFRD. In patients with CF and prediabetic conditions, after complete evaluation of the OGTT trend, glucometrics, glycemic values measured during pulmonary exacerbations and/or steroid therapy, early initiation of insulin therapy could have beneficial effects on clinical outcomes of patients with CF and prediabetes.
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Affiliation(s)
- Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
| | - Roberto Franceschi
- Pediatric Unit, S. Chiara Hospital, Trento, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
| | - Claudia Piona
- Regional Center for Pediatric Diabetes, University of Verona, Verona, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Alberto Casertano
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Dorina Pjetraj
- SOD Pediatric Diabetology, Department of Women’s and Children’s, “G. Salesi” Children’s Hospital, AOU Ospedali Riuniti, Ancona, Italy
| | - Giulio Maltoni
- Department of Woman, Child and Urological Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Valeria Calcaterra
- University of Pavia, Pavia and Department of Pediatrics, "Vittore Buzzi" Children’s Hospital, Milano, Italy
| | | | - Valentino Cherubini
- SOD Pediatric Diabetology, Department of Women’s and Children’s, “G. Salesi” Children’s Hospital, AOU Ospedali Riuniti, Ancona, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | | | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Donatella Lo Presti
- Centro di Riferimento Regionale di Diabetologia Pediatrica A.O.U. Policlinico G. Rodolico, Catania, Italy
| | | | - Elvira Piccinno
- D.A.I. Pediatria, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults - Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy
| | | | - Sonia Toni
- Pediatric Diabetology Unit, Meyer Children Hospital, Florence, Italy
| | - Stefano Zucchini
- Department of Woman, Child and Urological Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University of Verona, Verona, Italy
| | - Riccardo Schiaffini
- Diabetes Unit, Bambino Gesù Children’s Hospital, Rome, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
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13
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Iwanicki C, Logomarsino JV. Impaired glucose tolerance, body mass index and respiratory function in patients with cystic fibrosis: A systematic review. CLINICAL RESPIRATORY JOURNAL 2019; 13:341-354. [PMID: 30919537 DOI: 10.1111/crj.13019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/30/2018] [Accepted: 03/05/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This systematic review aims to evaluate body mass index (BMI) and forced expiratory volume in one second (FEV1 ) in patients with cystic fibrosis (CF) diagnosed with impaired glucose tolerance (IGT) compared to those with normal glucose tolerance (NGT). The significance of this topic stems from concern that individuals with CF and IGT may have an overall worse clinical status as indicated by BMI and FEV1 . DATA SOURCE An exhaustive literature search was completed between July 2017 and September 2017 using PubMed, CINAHL, Web of Science, Dissertations & Theses, PsycINFO, and Open Grey. Studies were limited to human subjects with CF. There were no restrictions on publication date, study design or language. STUDY SELECTION Included studies examined BMI and FEV1 as outcome measures in individuals with CF and IGT compared to those with NGT. After screening for inclusion criteria, 12 observational studies met the specified conditions. RESULTS Two studies showed a significantly worse BMI and FEV1 in subjects with CF and IGT compared to those with NGT. The remaining 10 studies found no significant associations with BMI and FEV1 in subjects with CF and IGT compared to NGT. CONCLUSION Although this review does not prove cause and effect, BMI and FEV1 are important outcome measures in patients with CF. Considering the inconclusive findings, practitioners should individualize care for this patient population. Additional research should focus on clinical status and interventions/treatment for individuals with CF and IGT.
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Affiliation(s)
- Courtney Iwanicki
- Division of Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
| | - John V Logomarsino
- Faculty, Nutrition & Dietetics, Department of Human Environmental Studies, Central Michigan University, The Villages, Florida
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14
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Colombo C, Alicandro G, Gambazza S, Mileto P, Mari A, Grespan E, Nazzari E, Russo MC, Battezzati A. Ventilation inhomogeneity is associated with OGTT-derived insulin secretory defects in cystic fibrosis. Pediatr Pulmonol 2019; 54:141-149. [PMID: 30575293 DOI: 10.1002/ppul.24212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/09/2018] [Indexed: 12/24/2022]
Abstract
Progressive deterioration of β-cell function is the main mechanism underlying diabetes in cystic fibrosis (CF). Diabetes negatively impacts the clinical status of CF patients years before its onset. We aimed to evaluate if OGTT-derived indices of β-cell function are associated with early markers of lung disease. We carried out a cross-sectional study on 80 CF patients who performed OGTT, spirometry, and nitrogen-multiple breath washout test. β-cell glucose sensitivity and the insulinogenic indices were used as markers of β-cell function and first-phase insulin response to glucose stimulus. We used sex- and age-adjusted multiple linear regression models to estimate the association between OGTT-derived indices and lung function measures. An increment of β-cell glucose sensitivity equal to its interquartile range was associated with an increase in ppFEV1 of 7.6 points (95%CI: 0.8; 14.4) as well as with a decrease in LCI of -1.96 units (95%CI: -3.40; -0.51) and in Scond of -0.016 L-1 (95%CI: -0.026; -0.007). The corresponding figures for insulinogenic index were: 8.6 (95%CI: 3.4; 13.9) for ppFEV1 , -2.03 (95%CI: -3.13; -0.94) for LCI, and -0.014 L-1 (95%CI: -0.021; -0.071) for Scond . When adjusting also for 2-h plasma glucose, both β-cell glucose sensitivity and insulinogenic index remained inversely associated with Scond . Deterioration of β-cell function is related to early lung disease in young patients with mild to normal pulmonary function. This relationship is independent from hyperglycemia and mainly involves conductive airways.
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Affiliation(s)
- Carla Colombo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Simone Gambazza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, U.O.C. Direzione delle Professioni Sanitarie, Milan, Italy
| | - Palmiro Mileto
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Andrea Mari
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Eleonora Grespan
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Erica Nazzari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Maria Chiara Russo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milan, Italy
| | - Alberto Battezzati
- Department of Food, Environmental and Nutritional Sciences, International Centre for the Assessment of Nutritional Status, University of Milan, Milan, Italy
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15
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Colomba J, Boudreau V, Lehoux-Dubois C, Desjardins K, Coriati A, Tremblay F, Rabasa-Lhoret R. The main mechanism associated with progression of glucose intolerance in older patients with cystic fibrosis is insulin resistance and not reduced insulin secretion capacity. J Cyst Fibros 2019; 18:551-556. [PMID: 30711385 DOI: 10.1016/j.jcf.2019.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/02/2018] [Accepted: 01/21/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Aging cystic fibrosis (CF) patients are at high risk of developing CF-related diabetes (CFRD). Decrease in insulin secretion over time is the main hypothesis to explain this increasing prevalence but mechanisms are still not well elucidated. The objective is to assess evolution of glucose tolerance and insulin secretion/sensitivity in aging CF patients. METHODS This is a retro-prospective observational analysis in the older adult CF patients from the Montreal Cystic Fibrosis Cohort (n = 46; at least 35 years old at follow-up) and followed for at least 4 years. Baseline and follow-up (last visit to date) 2-h oral glucose tolerance test (OGTT with glucose and insulin measurements every 30 min) were performed. Pulmonary function test (FEV1) and anthropometric data were measured the same day. Insulin sensitivity was measured by the Stumvoll index. RESULTS After a mean follow-up of 9.9 ± 2.6 years, mean age at follow-up was 43.5 ± 8.1 years old. An increase of body weight (+2.6 ± 6.5 kg, p = 0.01) and a decrease in pulmonary function (FEV1; 73.4 ± 21.2% to 64.5 ± 22.4%, p ≤ 0.001) were observed. Overall, insulin secretion is maintained at follow-up but all OGTT glucose values increased (for all values, p ≤ 0.028). At follow-up, 28.3% of patients had a normal glucose tolerance while 71.7% had abnormal glucose tolerance (AGT). AGT patients decreased their insulin sensitivity over time (p = 0.029) while it remained the same in NGT patients (p = 0.917). CONCLUSION In older CF patients, the progression of impaired glucose tolerance is occurring with stable insulin secretion but reduced insulin sensitivity.
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Affiliation(s)
- Johann Colomba
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada; Department of Nutrition, l'Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada
| | - Valérie Boudreau
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada; Department of Nutrition, l'Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada
| | - Catherine Lehoux-Dubois
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada; Department of Nutrition, l'Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada
| | - Katherine Desjardins
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada
| | - Adèle Coriati
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada
| | - François Tremblay
- Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montréal, QC H2X 3E4, Québec, Canada; Department of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, 110 avenue des Pins Ouest, Montréal H2W 1R7, Québec, Canada; Department of Nutrition, l'Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada; Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montréal, QC H2X 3E4, Québec, Canada; Department of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Québec, Canada.
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16
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Abstract
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasian patients. Continued advances have led to improved survival, and adults with CF now outnumber children. As our understanding of the disease improves, new therapies have emerged that improve the basic defect, enabling patient-specific treatment and improved outcomes. However, recurrent exacerbations continue to lead to morbidity and mortality, and new pathogens have been identified that may lead to worse outcomes. In addition, new complications, such as CF-related diabetes and increased risk of gastrointestinal cancers, are creating new challenges in management. For patients with end-stage disease, lung transplantation has remained one of the few treatment options, but challenges in identifying the most appropriate patients remain.
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Affiliation(s)
- Michael M Rey
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; , ,
| | - Michael P Bonk
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; , ,
| | - Denis Hadjiliadis
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; , ,
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17
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Abstract
INTRODUCTION There is a major epidemic of obesity, and many obese patients suffer with respiratory symptoms and disease. The overall impact of obesity on lung function is multifactorial, related to mechanical and inflammatory aspects of obesity. Areas covered: Obesity causes substantial changes to the mechanics of the lungs and chest wall, and these mechanical changes cause asthma and asthma-like symptoms such as dyspnea, wheeze, and airway hyperresponsiveness. Excess adiposity is also associated with increased production of inflammatory cytokines and immune cells that may also lead to disease. This article reviews the literature addressing the relationship between obesity and lung function, and studies addressing how the mechanical and inflammatory effects of obesity might lead to changes in lung mechanics and pulmonary function in obese adults and children. Expert commentary: Obesity has significant effects on respiratory function, which contribute significantly to the burden of respiratory disease. These mechanical effects are not readily quantified with conventional pulmonary function testing and measurement of body mass index. Changes in mediators produced by adipose tissue likely also contribute to altered lung function, though as of yet this is poorly understood.
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Affiliation(s)
- Anne E Dixon
- a Division of Pulmonary and Critical Care Medicine , University of Vermont Larner College of Medicine , Burlington , Vermont , USA
| | - Ubong Peters
- a Division of Pulmonary and Critical Care Medicine , University of Vermont Larner College of Medicine , Burlington , Vermont , USA
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18
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Bridges N, Rowe R, Holt RIG. Unique challenges of cystic fibrosis-related diabetes. Diabet Med 2018; 35:1181-1188. [PMID: 29687501 DOI: 10.1111/dme.13652] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 01/24/2023]
Abstract
Individuals with cystic fibrosis and pancreatic insufficiency have a gradual decline in insulin secretion over time, which results in an increase in the prevalence of diabetes with age; up to 50% of adults with cystic fibrosis aged over 35 years have diabetes. Cystic fibrosis-related diabetes differs from Type 1 and Type 2 diabetes in several ways; there is a pattern of insulin deficiency with reduced and delayed insulin response to carbohydrates but a sparing of basal insulin that results in glucose abnormalities, which are frequently characterized by normal fasting glucose and postprandial hyperglycaemia. Insulin deficiency and hyperglycaemia, even at levels which do not reach the threshold for a diagnosis of diabetes, have an adverse impact on lung function and clinical status in people with cystic fibrosis. Although the risk of microvascular complications occurs as in other forms of diabetes, the main reason for treatment is to prevent deterioration in lung function and weight loss; treatment may therefore be required at an earlier stage than for other types of diabetes. Treatment is usually with insulin, but management needs to take into account all the other medical issues that arise in cystic fibrosis.
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Affiliation(s)
- N Bridges
- Chelsea and Westminster Hospital, London and the Royal Brompton Hospital, London, UK
| | - R Rowe
- University Hospital of South Manchester, Manchester, UK
| | - R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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19
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Lecube A, Simó R, Pallayova M, Punjabi NM, López-Cano C, Turino C, Hernández C, Barbé F. Pulmonary Function and Sleep Breathing: Two New Targets for Type 2 Diabetes Care. Endocr Rev 2017; 38:550-573. [PMID: 28938479 DOI: 10.1210/er.2017-00173] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
Population-based studies showing the negative impact of type 2 diabetes (T2D) on lung function are overviewed. Among the well-recognized pathophysiological mechanisms, the metabolic pathways related to insulin resistance (IR), low-grade chronic inflammation, leptin resistance, microvascular damage, and autonomic neuropathy are emphasized. Histopathological changes are exposed, and findings reported from experimental models are clearly differentiated from those described in humans. The accelerated decline in pulmonary function that appears in patients with cystic fibrosis (CF) with related abnormalities of glucose tolerance and diabetes is considered as an example to further investigate the relationship between T2D and the lung. Furthermore, a possible causal link between antihyperglycemic therapies and pulmonary function is examined. T2D similarly affects breathing during sleep, becoming an independent risk factor for higher rates of sleep apnea, leading to nocturnal hypoxemia and daytime sleepiness. Therefore, the impact of T2D on sleep breathing and its influence on sleep architecture is analyzed. Finally, the effect of improving some pathophysiological mechanisms, primarily IR and inflammation, as well as the optimization of blood glucose control on sleep breathing is evaluated. In summary, the lung should be considered by those providing care for people with diabetes and raise the central issue of whether the normalization of glucose levels can improve pulmonary function and ameliorate sleep-disordered breathing. Therefore, patients with T2D should be considered a vulnerable group for pulmonary dysfunction. However, further research aimed at elucidating how to screen for the lung impairment in the population with diabetes in a cost-effective manner is needed.
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Affiliation(s)
- Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Rafael Simó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Maria Pallayova
- Department of Medicine, Weill Cornell Medicine.,Department of Human Physiology and Sleep Laboratory, Faculty of Medicine, Pavol Jozef Šafárik University, Slovak Republic
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cecilia Turino
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cristina Hernández
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Ferran Barbé
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain
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20
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Yoon JC. Evolving Mechanistic Views and Emerging Therapeutic Strategies for Cystic Fibrosis-Related Diabetes. J Endocr Soc 2017; 1:1386-1400. [PMID: 29264462 PMCID: PMC5686691 DOI: 10.1210/js.2017-00362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/25/2017] [Indexed: 12/19/2022] Open
Abstract
Diabetes is a common and important complication of cystic fibrosis, an autosomal recessive genetic disease due to mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Cystic fibrosis-related diabetes (CFRD) is associated with profound detrimental effects on the disease course and mortality and is expected to increase in prevalence as the survival of patients with cystic fibrosis continues to improve. Despite progress in the functional characterization of CFTR molecular defects, the mechanistic basis of CFRD is not well understood, in part because of the relative inaccessibility of the pancreatic tissue and the limited availability of representative animal models. This review presents a concise overview of the current understanding of CFRD pathogenesis and provides a cutting-edge update on novel findings from human and animal studies. Potential contributions from paracrine mechanisms and β-cell compensatory mechanisms are highlighted, as well as functional β-cell and α-cell defects, incretin defects, exocrine pancreatic insufficiency, and loss of islet cell mass. State-of-the-art and emerging treatment options are explored, including advances in insulin administration, CFTR modulators, cell replacement, gene replacement, and gene editing therapies.
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Affiliation(s)
- John C Yoon
- Division of Endocrinology, Department of Internal Medicine, University of California Davis School of Medicine, Davis, California 95616
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21
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Peters U, Suratt BT, Bates JHT, Dixon AE. Beyond BMI: Obesity and Lung Disease. Chest 2017; 153:702-709. [PMID: 28728934 DOI: 10.1016/j.chest.2017.07.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022] Open
Abstract
The worldwide prevalence of obesity has increased rapidly in the last 3 decades, and this increase has led to important changes in the pathogenesis and clinical presentation of many common diseases. This review article examines the relationship between obesity and lung disease, highlighting some of the major findings that have advanced our understanding of the mechanisms contributing to this relationship. Changes in pulmonary function related to fat mass are important, but obesity is much more than simply a state of mass loading, and BMI is only a very indirect measure of metabolic health. The obese state is associated with changes in the gut microbiome, cellular metabolism, lipid handling, immune function, insulin resistance, and circulating factors produced by adipose tissue. Together, these factors can fundamentally alter the pathogenesis and pathophysiology of lung health and disease.
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22
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Kessler L, Abély M. Atteinte pancréatique exocrine et endocrine dans la mucoviscidose. Arch Pediatr 2016; 23:12S21-12S32. [DOI: 10.1016/s0929-693x(17)30059-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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23
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Belle-van Meerkerk G, de Valk HW, Stam-Slob MC, Teding van Berkhout F, Zanen P, van de Graaf EA. Cystic Fibrosis-Related Diabetes with strict glycaemic control is not associated with frequent intravenous antibiotics use for pulmonary infections. Diabetes Res Clin Pract 2016; 116:230-6. [PMID: 27321340 DOI: 10.1016/j.diabres.2016.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/14/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
AIMS Pulmonary infections are more frequent in and associated with higher mortality in Cystic Fibrosis-Related Diabetes (CFRD) patients compared to CF patients without CFRD. Hyperglycaemia can lead to a higher vulnerability for infections. Aim of the study was to test whether the infection rate in well-controlled CFRD patients was similar to that in CF patients without CFRD. METHODS This is a retrospective six-year cohort analysis on a consecutive series of 138 CF patients. They were categorized in two groups with CFRD or without CFRD. Pulmonary infection frequency was defined as the number of intravenous (IV) antibiotic treatments. Clinical factors associated with infection frequency were collected. RESULTS CFRD was diagnosed in 54 (39%) CF patients of whom 44 (81%) achieved target value for glycaemic control (HbA1c 7.0% (⩽53mmol/mol)). Median frequency of IV antibiotics was 0 without CFRD and 3 episodes in patients with CFRD (rate ratio (RR) 2.9 (95% CI 1.6-5.2)). Multivariate analysis showed that frequency of IV antibiotics was significantly related to Pseudomonas aeruginosa colonization (RR 3.7) and lower lung function at baseline (RR 0.97) but not to CFRD by itself. CONCLUSIONS In this cohort with overall strict glycaemic control, the frequency of IV antibiotics use was related to chronic infection and impaired lung function at baseline, but not to CFRD by itself. Although this study in itself does not prove beneficial effect of strict glycaemic control, it does emphasize the potential role of glycaemic control on infection frequency in CF patients.
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Affiliation(s)
- G Belle-van Meerkerk
- Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - H W de Valk
- Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - M C Stam-Slob
- Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F Teding van Berkhout
- Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - P Zanen
- Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - E A van de Graaf
- Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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