The Adult Cystic Fibrosis Unit, The Cardiothoracic Centre NHS Trust, Liverpool L143PE, UK.
Diabet Med. 2009 Jun;26(6):582-8. doi: 10.1111/j.1464-5491.2009.02738.x.
Although cystic fibrosis-related diabetes (CFRD), a poor prognostic factor in cystic fibrosis (CF), is characterized by insulinopenia, the role of insulin resistance is unclear. Using a prospective study design, we measured insulin resistance, pancreatic beta-cell function and correlated glycaemic status with clinical parameters.
Oral glucose tolerance test was performed in 60 stable adult CF patients. Insulin sensitivity and beta-cell function were measured using the homeostatic model assessment (HOMA2), Stumvoll and oral glucose insulin sensitivity (OGIS) indices.
Forty-two (70%) had normal glucose tolerance (NGT), 10 (17%) impaired glucose tolerance (IGT) and eight (13%) CFRD. There was no difference in insulin sensitivity among the three groups (HOMA2: NGT 280, IGT 250, CFRD 339, P = 0.42; Stumvoll: NGT 0.128, IGT 0.126, CFRD 0.129, P = 0.76; and OGIS: NGT 515, IGT 472, CFRD 472, P = 0.12). Pancreatic beta-cell function (CFRD 50% vs. NGT 67%; P < 0.05) and first-phase insulin secretion were reduced in CFRD (250 vs. NGT 509; P = 0.004). First-phase insulin secretion was inversely correlated with 1-h (r = -0.74; P < 0.0001) and 2-h glucose levels (r = -0.34; P < 0.05). There was no difference in body mass index or poor lung function (forced expiratory volume in 1 s: CFRD 54% vs. NGT 65%; P = 0.43). However, there were more hospital admissions in the CFRD group (three vs. NGT one per patient per year; P < 0.05).
CFRD is characterized by qualitative and quantitative defects in insulin secretion, but not insulin resistance, and is associated with increased hospital admissions for pulmonary exacerbations.
虽然囊性纤维化相关糖尿病（CFRD）是囊性纤维化（CF）的一个预后不良因素，但它以胰岛素缺乏为特征，而胰岛素抵抗的作用尚不清楚。我们采用前瞻性研究设计，测量了胰岛素抵抗、胰岛β细胞功能，并将血糖状态与临床参数相关联。
对 60 例稳定的成年 CF 患者进行口服葡萄糖耐量试验。使用稳态模型评估（HOMA2）、Stumvoll 和口服葡萄糖胰岛素敏感性（OGIS）指数来测量胰岛素敏感性和胰岛β细胞功能。
42 例（70%）患者糖耐量正常（NGT），10 例（17%）患者糖耐量受损（IGT），8 例（13%）患者患有 CFRD。三组之间的胰岛素敏感性无差异（HOMA2：NGT 280，IGT 250，CFRD 339，P=0.42；Stumvoll：NGT 0.128，IGT 0.126，CFRD 0.129，P=0.76；OGIS：NGT 515，IGT 472，CFRD 472，P=0.12）。CFRD 患者的胰岛β细胞功能（CFRD 50% vs. NGT 67%；P<0.05）和第一时相胰岛素分泌减少（250 vs. NGT 509；P=0.004）。第一时相胰岛素分泌与 1 小时（r=-0.74；P<0.0001）和 2 小时血糖水平呈负相关（r=-0.34；P<0.05）。体重指数或肺功能不良无差异（用力呼气量 1 秒：CFRD 54% vs. NGT 65%；P=0.43）。然而，CFRD 组的住院次数更多（每例患者每年 CFRD 组 3 次，NGT 组 1 次；P<0.05）。
CFRD 的特征是胰岛素分泌的质和量的缺陷，但不存在胰岛素抵抗，与因肺部恶化而住院的次数增加有关。
