Highlights
- •Children and adults with cystic fibrosis show disturbed circadian glucose patterns on CGM after impaired OGTT and/or increased HbA1c.
- •Abnormal circadian glucose patterns are not associated with pulmonary and anthropometric outcome parameters in children with cystic fibrosis.
- •Abnormal glucose patterns during the night are associated with a worse pulmonary function in adults with cystic fibrosis.
- •It is warranted to standardize the use of CGM methodology in cystic fibrosis.
Abstract
Introduction
In patients with cystic fibrosis (CF), it is still unclear to which extent glucose
abnormalities – preceding the diagnosis of cystic fibrosis related diabetes (CFRD)
– are associated with pulmonary and nutritional outcome parameters. This study related
circadian glycemic patterns to clinical outcomes in a group of CF patients not previously
diagnosed with diabetes.
Methods
Continuous glucose monitoring (CGM) readings (7 days) of 47 CF patients (26 children,
21 adults) with an impaired oral glucose tolerance test (OGTT) (n = 25) and/or increased Hb1Ac (> 5.5%) were analyzed. Biometric, pulmonary function
and clinical parameters were retrospectively collected over a period of 1 year before
(T-1) and 1 year after (T + 1) CGM (T0).
Results
96% (45/47) of CGM readings showed glucose values > 140 mg/dL ≥ 4.5% of the time and
at least one ≥ 200 mg/dL. In the pediatric cohort, no significant associations were
found between CGM parameters and pulmonary and nutritional outcome parameters. In
the adult cohort, an area under the curve (AUC) > 140 mg/dL and%-time > 140 mg/dL
during the night were associated with a lower forced expiratory volume in 1 s (FEV1)%
predicted (pp) at time of evaluation but not with change in FEV1pp.
Conclusion
This is the first study reporting the circadian glycemic pattern in children and adults
at risk for CFRD. In the adult cohort an association between detection of abnormal
glucose exposure and a lower FEV1pp was found. Our results support continued screening
for glucose intolerance in patients with CF.
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Article info
Publication history
Published online: September 04, 2022
Accepted:
August 24,
2022
Received in revised form:
July 17,
2022
Received:
March 18,
2022
Identification
Copyright
© 2022 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Early Glucose abnormalities in cystic fibrosis – how best to measure them, and what is to be done about them?Journal of Cystic FibrosisVol. 22Issue 1
- PreviewIn recent decades, two concepts have grown to increasing prominence in the field of cystic fibrosis related diabetes (CFRD). The first notion is that glucose abnormalities can be detected well before the diagnosis of CFRD can be made using current diagnostic criteria. The second concept is that it is biologically plausible that these glucose abnormalities may be of clinical importance to people with cystic fibrosis (via mechanisms that include increasing glucose in airway secretions [1], thereby promoting respiratory infections, as well as through catabolism from reduced secretion of insulin, a potent anabolic hormone [2].
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