Bizzarri C, Lucidi V, Ciampalini P, Bella S, Russo B, Cappa M
Unit of Endocrinology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy.
J Endocrinol Invest. 2006 Mar;29(3):RC1-4. doi: 10.1007/BF03345538.
Diabetes mellitus is an increasing complication of cystic fibrosis (CF), as a result of the improved life expectancy. There is clear association between diabetes and increased morbidity and mortality. Lung function and clinical status deteriorate up to 2-4 yr before the diagnosis of CF-related diabetes (CFRD). The aim of our study was to evaluate the effects, on glucose homeostasis and clinical status, of the early treatment with insulin glargine in CF patients with impaired glucose tolerance (IGT). We selected six subjects with IGT diagnosed at oral glucose tolerance test (OGTT). Median age was 18.12 yr (range 9.2-27.8). Insulin glargine was administered at the median dosage of 0.3 U/kg/day (range 0.2-0.5). After the initial adjustment of the dosage, no patient manifested hypoglycemia during treatment. Median glycosylated hemoglobin (HbA1c) did not show any significant variation during treatment: it was 5.9% at baseline (range 5.5-6.2) and 6.1% (range 5.0-6.7) at the end of follow-up (p=0.496). Median body mass index (BMI) z-score significantly increased during treatment, from -0.95 (range -3.2-+0.6) at baseline to -0.5. (range -3.0-+0.9) at the end of follow-up (p=0.026). Lung function, measured by median forced expiratory volume in the first second (FEV1%), showed a mild but significant improvement during insulin treatment. It was 72.7% at baseline (range 41.5-98.4) and 76.7% (range 42.0-106.8) at the end of follow-up (p=0.027). No significant variation was found between the number of hospitalizations for clinical exacerbation (no./patient/yr) in the last 2 yr before treatment and during follow-up. Median number at baseline was 1.95/patient/yr (range 1-3) and 2.0/patient/yr (range 1-3) at follow-up (p=0.715). Our data seem to indicate that early insulin therapy can be safe, no patient manifested hypoglycemia or other adverse effects during treatment. Insulin is an anabolic hormone implicated in both lipid and protein metabolism. The appearance of IGT out of infections can indicate an early insulin deficiency, with a potential impact on the nutritional and clinical status of the patient, even before the appearance of overt diabetes. Larger controlled trials are necessary to verify if early insulin therapy is able to reduce the deterioration of nutritional status and lung function associated with the onset of IGT.
由于预期寿命的延长，糖尿病已成为囊性纤维化（CF）日益常见的并发症。糖尿病与发病率和死亡率的增加之间存在明显关联。在囊性纤维化相关糖尿病（CFRD）诊断前2至4年，肺功能和临床状况就会恶化。我们研究的目的是评估甘精胰岛素早期治疗对糖耐量受损（IGT）的CF患者葡萄糖稳态和临床状况的影响。我们选择了6名在口服葡萄糖耐量试验（OGTT）中诊断为IGT的受试者。中位年龄为18.12岁（范围9.2 - 27.8岁）。甘精胰岛素的给药中位剂量为0.3 U/kg/天（范围0.2 - 0.5）。在初始剂量调整后，治疗期间没有患者出现低血糖。糖化血红蛋白（HbA1c）中位数在治疗期间没有显示出任何显著变化：基线时为5.9%（范围5.5 - 6.2），随访结束时为6.1%（范围5.0 - 6.7）（p = 0.496）。治疗期间，体重指数（BMI）z评分中位数显著增加，从基线时的 - 0.95（范围 - 3.2至 + 0.6）增加到随访结束时的 - 0.5（范围 - 3.0至 + 0.9）（p = 0.026）。通过第一秒用力呼气量（FEV1%）中位数测量的肺功能在胰岛素治疗期间有轻微但显著的改善。基线时为72.7%（范围41.5 - 98.4），随访结束时为76.7%（范围42.0 - 106.8）（p = 0.027）。治疗前最后2年和随访期间临床病情加重的住院次数（次/患者/年）没有显著差异。基线时的中位数为1.95次/患者/年（范围1 - 3），随访时为2.0次/患者/年（范围1 - 3）（p = 0.715）。我们的数据似乎表明早期胰岛素治疗可能是安全的，治疗期间没有患者出现低血糖或其他不良反应。胰岛素是一种参与脂质和蛋白质代谢的合成代谢激素。感染后出现IGT可能表明早期胰岛素缺乏，甚至在显性糖尿病出现之前就可能对患者的营养和临床状况产生潜在影响。需要更大规模的对照试验来验证早期胰岛素治疗是否能够减少与IGT发生相关的营养状况和肺功能恶化。
