Department of Pediatrics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
Pediatr Diabetes. 2010 Nov;11(7):487-92. doi: 10.1111/j.1399-5448.2009.00632.x.
Cystic fibrosis (CF) related diabetes is the most common comorbidity in persons with CF. International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines recommend annual oral glucose tolerance testing (OGTT) screening starting at age 10. The OGTT might be recommended in younger children if, as in adults, it provided clinically relevant prognostic information. A database review was performed to determine whether OGTT findings in children with CF predict subsequent clinical course.
A retrospective matched-pair cohort study was based on OGTTs performed during 1998-2003. Children aged 6-9 were classified as having normal glucose tolerance (NGT) or abnormal glucose tolerance (AGT). Children with AGT were matched by age and gender to those with NGT. Clinical status was assessed at baseline and 5 yr later. In a separate investigation, diabetes and prior AGT status of children aged 10-18 were used to assess predictions derived from the cohort study.
In 1998-2003, 39 of 94 children had AGT. Of these, 31 had sufficient follow-up data to be included. Both at baseline and 5 yr later there was no significant difference in height, weight, body mass index (BMI) or lung function between AGT and NGT. Diabetes developed in 13 AGT (42%) and one NGT (3%) [odds ratio (OR) 11, p = 0.0009]. Age of diabetes onset was 12 ± 1 yr in boys and 11 ± 1 yr in girls, compared to approximately 23 yr in the general CF population. Fifteen current children age 10-18 who had AGT before age 10 have diabetes, close to the prediction of 19.
AGT in children with CF age 6-9 yr identifies those at high risk for progression to early onset diabetes.
囊性纤维化（CF）相关糖尿病是 CF 患者最常见的合并症。国际儿科青少年糖尿病学会（ISPAD）指南建议从 10 岁开始每年进行口服葡萄糖耐量试验（OGTT）筛查。如果像在成年人中一样，OGTT 提供了有临床意义的预后信息，那么可能会建议在年龄较小的儿童中进行检查。进行了数据库回顾，以确定 CF 患儿的 OGTT 结果是否可预测随后的临床病程。
回顾性匹配对队列研究基于 1998-2003 年进行的 OGTT。6-9 岁的儿童被分为正常葡萄糖耐量（NGT）或异常葡萄糖耐量（AGT）。通过年龄和性别与 NGT 相匹配的 AGT 儿童。在基线和 5 年后评估临床状况。在另一项研究中，根据队列研究，使用 10-18 岁儿童的糖尿病和先前的 AGT 状态评估预测结果。
在 1998-2003 年，94 名儿童中有 39 名出现 AGT。其中，有 31 名有足够的随访数据被纳入。在基线和 5 年后，AGT 和 NGT 之间在身高、体重、体重指数（BMI）或肺功能方面均无显著差异。在 31 名 AGT 儿童中，有 13 名（42%）发生了糖尿病，而在 3 名 NGT 儿童中，有 1 名（3%）[比值比（OR）为 11，p=0.0009]。男孩的糖尿病发病年龄为 12 ± 1 岁，女孩为 11 ± 1 岁，而普通 CF 人群的发病年龄约为 23 岁。目前有 15 名 10-18 岁的儿童在 10 岁之前出现过 AGT，已患有糖尿病，接近预测值 19。
6-9 岁 CF 儿童的 AGT 可识别出那些有进展为早发糖尿病高风险的患者。
