Endocrinology and Diabetes Unit, University Department of Paediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Piazza S Onofrio 4, 00165 Rome, Italy.
Eur J Endocrinol. 2010 Apr;162(4):705-10. doi: 10.1530/EJE-09-1020. Epub 2010 Jan 13.
A long pre-diabetic phase of abnormal glucose tolerance is described in subjects with cystic fibrosis (CF) since childhood.
The aims of the study were to compare oral glucose tolerance test (OGTT) and continuous glucose monitoring system (CGMS) in the diagnosis of altered glucose metabolism, and to longitudinally evaluate the role of CGMS in predicting glucose metabolism deterioration in children with CF.
Seventeen children with CF and 14 controls were enrolled (mean age 13.3+/-3.0 years). All subjects underwent OGTT and CGMS registration. On the basis of OGTT, children were classified as normal glucose tolerance, impaired glucose tolerance (IGT), IGT plus at least one glucose value above 200 mg/dl at intermediate OGTT points (IGT+200) and CF-related diabetes (CFRD). HbA1c, glucose area under the curve, insulin sensitivity, and insulinogenic and disposition indexes were also considered. Subjects with CF underwent another OGTT after 2.5 years.
Baseline OGTT revealed 3/17 (7.6%) children with CF with at least one glucose value above 200 mg/dl (1 CFRD and 2 IGT+200), while CGMS revealed 6/17 (35.3%) children with glucose excursions above 200 mg/dl (P=0.010). None of the controls showed glucose over 200 mg/dl either at OGTT or at CGMS. At the 2.5-year follow-up OGTT, all the six subjects who had diabetic glucose excursion (i.e. >200 mg/dl) at baseline CGMS presented IGT+200 or CFRD. In logistic regression analysis, CGMS diabetic excursion was the strongest predictor of IGT+200 and CFRD (P<0.001).
CGMS could be a useful tool to predict glucose metabolism derangements in children affected by CF.
本研究旨在比较口服葡萄糖耐量试验（OGTT）和连续血糖监测系统（CGMS）在诊断糖代谢异常中的作用，并纵向评估 CGMS 在预测 CF 儿童糖代谢恶化中的作用。
纳入 17 名 CF 患儿和 14 名对照者（平均年龄 13.3+/-3.0 岁）。所有受试者均行 OGTT 和 CGMS 登记。根据 OGTT，患儿分为正常糖耐量、糖耐量受损（IGT）、IGT 伴中间点 OGTT 至少一个血糖值>200mg/dl（IGT+200）和 CF 相关糖尿病（CFRD）。还考虑了糖化血红蛋白（HbA1c）、血糖曲线下面积、胰岛素敏感性、胰岛素原和处置指数。CF 患儿在 2.5 年后再次进行 OGTT。
基线 OGTT 显示 3/17（7.6%）名 CF 患儿至少有一个血糖值>200mg/dl（1 例 CFRD 和 2 例 IGT+200），而 CGMS 显示 6/17（35.3%）名 CF 患儿的血糖值超过 200mg/dl（P=0.010）。对照组在 OGTT 或 CGMS 中均无血糖>200mg/dl。在 2.5 年随访的 OGTT 中，所有在基线 CGMS 时出现糖尿病血糖升高（即>200mg/dl）的 6 名患者均表现为 IGT+200 或 CFRD。在逻辑回归分析中，CGMS 糖尿病波动是预测 IGT+200 和 CFRD 的最强预测因子（P<0.001）。
CGMS 可作为预测 CF 患儿糖代谢紊乱的有用工具。
