scholarly journals Detection and Management of Early Glucose Abnormalities in Cystic Fibrosis

2021 ◽  
Author(s):  
Katerina Theocharous ◽  
Bernadette Prentice ◽  
Charles F. Verge ◽  
Adam Jaffé ◽  
Shihab Hameed
Keyword(s):  
Cystic Fibrosis ◽  
Early Intervention ◽  
Glucose Tolerance ◽  
Treatment Outcomes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Oral Glucose Tolerance Testing ◽  
Glucose Abnormalities

With advances in technology, it is now possible to detect the emergence of glucose abnormalities in cystic fibrosis with improved sensitivity, and from a very early age. These abnormalities are increasingly recognized as predictors of clinical decline, raising the possibility that early intervention may slow or prevent this deterioration. In this chapter, we will review the available literature on methods of detecting glucose abnormalities in cystic fibrosis (random and fasting glucose, HbA1c, oral glucose tolerance testing, and continuous glucose monitoring), and detail their advantages and possible limitations in the interpretation of glycemic data. We will also discuss treatment outcomes of early intervention, prior to the diagnosis of diabetes as currently defined.

Continuous Glucose Monitoring and HbA1c in Cystic Fibrosis: Clinical Correlations and Implications for CFRD Diagnosis

2021 ◽  
Author(s):  
Kevin J Scully ◽  
Jordan S Sherwood ◽  
Kimberly Martin ◽  
Melanie Ruazol ◽  
Peter Marchetti ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Glucose Tolerance ◽  
Continuous Glucose Monitoring ◽  
Regression Line ◽  
Glucose Monitoring ◽  
Area Under The Curve ◽  
Glycemic Variability ◽  
Oral Glucose ◽  
Oral Glucose Tolerance Testing ◽  
Significant Difference

Abstract Context The clinical utility and implications of continuous glucose monitoring (CGM) in cystic fibrosis (CF) are unclear. Objective We examined the correlation between CGM measures and clinical outcomes in adults with CF, investigated the relationship between hemoglobin A1c (HbA1c) and CGM-derived average glucose (AG), and explored CGM measures that distinguish CFRD from normal and abnormal glucose tolerance. Design Prospective observational study. Participants 77 adults with CF. Main outcomes CGM and HbA1c measured at 2-3 time-points three months apart. Results Thirty-one of the 77 participants met American Diabetes Association-recommended diagnostic criteria for CFRD by oral glucose tolerance testing and/or HbA1c. In all participants, CGM measures of hyperglycemia and glycemic variability correlated with nutritional status and pulmonary function. HbA1c was correlated with AG (R 2=0.71, p=<0.001), with no significant difference between this regression line and that previously established in type 1 and type 2 diabetes and healthy volunteers. Cutoffs of 17.5% time >140 mg/dL and 3.4% time >180 mg/dL had sensitivities of 87% and 90%, respectively, and specificities of 95%, for identifying CFRD. Area under the curve and percent of participants correctly classified with CFRD were higher for AG, standard deviation, % time >140, >180, and >250 mg/dL than HbA1c. Conclusions CGM measures of hyperglycemia and glycemic variability are superior to HbA1c in distinguishing those with and without CFRD. CGM-derived AG is strongly correlated with HbA1c in adults with CF, with a similar relationship to other diabetes populations. Future studies are needed to investigate CGM as a diagnostic and screening tool for CFRD.

scholarly journals Applicability of continuous glucose monitoring to screen for cystic fibrosis-related diabetes onset and clinical impairment

2021 ◽  
Author(s):  
Mariana Zorron ◽  
Fernando Marson ◽  
André Morcillo ◽  
Aline Gonçalves ◽  
Mayra de Souza El Beck ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cystic Fibrosis ◽  
Glucose Tolerance ◽  
Body Mass ◽  
Continuous Glucose Monitoring ◽  
Glucose Tolerance Test ◽  
Glucose Monitoring ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance

Background and Objectives: Cystic fibrosis-related diabetes is the major comorbidity in cystic fibrosis and reduces life expectancy, highlighting the need for early diagnosis and treatment. This study aimed to verify whether abnormal continuous glucose monitoring results predict cystic fibrosis-related diabetes onset and/or a decline in the forced expiratory volume in the 1st second or body mass index of patients with cystic fibrosis. Methods: Thirty-nine patients with cystic fibrosis (age 10–19 years) were screened for cystic fibrosis-related diabetes using the oral glucose tolerance test. Patients without diabetes diagnose underwent 3 days of continuous glucose monitoring, spirometry and body mass index measurements and were reassessed at the end of the study with a second spirometry, body mass index evaluation and oral glucose tolerance test. Results: Thirty-four patients completed the follow-up (3.1±0.51 years). None of the study variables predicted cystic fibrosis-related diabetes progression or were associated with hypoglycemic events. Continuous glucose monitoring could detect glucose abnormalities not revealed in the oral glucose tolerance test. Patients with glucose level of >140 mg/dL on continuous glucose monitoring showed significantly lower body mass index z scores at both study initiation (-1.55±1.68 vs. -0.17±0.88; p-value=0.02) and completion (-1.65±1.55 vs. -0.42±1.08; p-value=0.039). Conclusions: Continuous glucose monitoring can identify glucose abnormalities not detected by oral glucose tolerance test that are related to early stage decreases in body mass index. However, it was ineffective in predicting the onset of diabetes in this cystic fibrosis population. Different diagnostic criteria for diabetes may be required for individuals with cystic fibrosis.

Oral glucose tolerance test and continuous glucose monitoring to assess diabetes development in cystic fibrosis patients

2018 ◽  
Vol 65 (1) ◽  
pp. 45-51 ◽  
Author(s):  
María Clemente León ◽  
Laura Bilbao Gassó ◽  
Antonio Moreno-Galdó ◽  
Ariadna Campos Martorrell ◽  
Silvia Gartner Tizzano ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Continuous Glucose Monitoring ◽  
Glucose Tolerance Test ◽  
Glucose Monitoring ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Diabetes Development

Full The Relationship between Continuous Glucose Monitoring and OGTT in Youth and Young Adults with Cystic Fibrosis

2021 ◽  
Author(s):  
Christine L Chan ◽  
Laura Pyle ◽  
Tim Vigers ◽  
Philip S Zeitler ◽  
Kristen J Nadeau
Keyword(s):  
Cystic Fibrosis ◽  
Continuous Glucose Monitoring ◽  
Cell Function ◽  
Glucose Monitoring ◽  
Oral Glucose ◽  
Β Cell ◽  
Oral Glucose Tolerance Testing ◽  
C Peptide ◽  
Β Cell Function ◽  
The Relationship

Abstract Context Early glucose abnormalities in people with CF (PwCF) are commonly detected by continuous glucose monitoring (CGM). Relationships between these CGM abnormalities and oral glucose tolerance testing (OGTT) in PwCF have not been fully characterized. Objective(s) 1) To determine the relationship between CGM and common OGTT-derived estimates of β-cell function, including C-peptide index and oral disposition index (oDI) and 2) to explore whether CGM can be used to screen for OGTT-defined prediabetes and cystic fibrosis related diabetes (CFRD). Study Design/Methods PwCF not on insulin and healthy controls ages 6-25 yrs were enrolled in a prospective study collecting OGTT and CGM. A subset underwent frequently-sampled OGTTs (fsOGTT) with 7-point glucose, insulin, and C-peptide measurements. Pearson’s correlation coefficient was used to test the association between select CGM and fsOGTT measures. ROC analysis was applied to CGM variables to determine the cutoff optimizing sensitivity and specificity for detecting prediabetes and CFRD. Results A total of 120 participants (controls=35, CF=85), including 69 with fsOGTTs, were included. CGM coefficient of variation correlated inversely with C-peptide index (Cpeptide30-Cpeptide0/Glucose30-Glucose0) (r=-0.45, p<0.001) and oDIcpeptide (C-peptide index)(1/cpep0) (r=-0.48, p<0.0001). In PwCF, CGM variables had ROC-AUCs ranging from 0.43-0.57 for prediabetes and 0.47-0.6 for CFRD. Conclusions Greater glycemic variability on CGM correlated with reduced β-cell function. However, CGM performed poorly at discriminating individuals with and without OGTT-defined CFRD and prediabetes. Prospective studies are now needed to determine how well the different tests predict clinically-relevant non-glycemic outcomes in PwCF.

Trajectories of oral glucose tolerance testing in cystic fibrosis

2020 ◽  
Author(s):  
Monal Patel ◽  
Courtney McCracken ◽  
Tanicia Daley ◽  
Arlene Stecenko ◽  
Rachel Linnemann
Keyword(s):  
Cystic Fibrosis ◽  
Glucose Tolerance ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Oral Glucose Tolerance Testing ◽  
Tolerance Testing
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