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Glycemic indices at night measured by CGM are predictive for a lower pulmonary function in adults but not in children with cystic fibrosis

  • Dimitri Declercq
    Correspondence
    Corresponding author at: Cystic Fibrosis Reference Centre 3K12D, C. Heymanslaan 10, Ghent 9000, Belgium.
    Affiliations
    Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium

    Department of Pediatrics, Centre for Children and Adolescents with Diabetes, Ghent University Hospital, Ghent, Belgium

    Centre for Nutrition and Dietetics, Ghent University Hospital, Ghent, Belgium

    Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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  • Simon Helleputte
    Affiliations
    Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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  • Sophie Marchand
    Affiliations
    Centre for Nutrition and Dietetics, Ghent University Hospital, Ghent, Belgium
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  • Sara Van Aken
    Affiliations
    Department of Pediatrics, Centre for Children and Adolescents with Diabetes, Ghent University Hospital, Ghent, Belgium
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  • Eva Van Braeckel
    Affiliations
    Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Department of Respiratory Medicine, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium
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  • Sabine Van daele
    Affiliations
    Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium

    Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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  • Guy T'Sjoen
    Affiliations
    Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
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  • Stephanie Van Biervliet
    Affiliations
    Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium

    Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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  • Bruno Lapauw
    Affiliations
    Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
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Published:September 04, 2022DOI:https://doi.org/10.1016/j.jcf.2022.08.016

      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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