Kayani Kayani, Mohammed Raihan, Mohiaddin Hasan
Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom.
Faculty of Medicine, Imperial College London, London, United Kingdom.
Front Endocrinol (Lausanne). 2018 Feb 20;9:20. doi: 10.3389/fendo.2018.00020. eCollection 2018.
Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasian populations. Individuals with CF have seen significant increases in life expectancy in the last 60 years. As a result, previously rare complications are now coming to light. The most common of these is cystic fibrosis-related diabetes (CFRD), which affects 40-50% of CF adults. CFRD significantly impacts the pulmonary function and longevity of CF patients, yet a lack of consensus on the best methods to diagnose and treat CFRD remains. We begin by reviewing our understanding of the pathogenesis of CFRD, as emerging evidence shows the cystic fibrosis transmembrane conductance regulator (CFTR) also has important roles in the release of insulin and glucagon and in the protection of β cells from oxidative stress. We then discuss how current recommended methods of CFRD diagnosis are not appropriate, as continuous glucose monitoring becomes more effective, practical, and cost-effective. Finally, we evaluate emerging treatments which have narrowed the mortality gap within the CF patient group. In the future, pharmacological potentiators and correctors directly targeting CFTR show huge promise for both CFRD and the wider CF patient groups.
囊性纤维化(CF)是白种人群中最常见的常染色体隐性疾病。在过去60年里,CF患者的预期寿命显著增加。因此,以前罕见的并发症现在逐渐显现出来。其中最常见的是囊性纤维化相关糖尿病(CFRD),它影响40%至50%的成年CF患者。CFRD对CF患者的肺功能和寿命有重大影响,但在CFRD的最佳诊断和治疗方法上仍缺乏共识。我们首先回顾一下我们对CFRD发病机制的理解,因为新出现的证据表明,囊性纤维化跨膜传导调节因子(CFTR)在胰岛素和胰高血糖素的释放以及保护β细胞免受氧化应激方面也起着重要作用。然后我们讨论当前推荐的CFRD诊断方法如何不合适,因为持续血糖监测变得更有效、实用且具有成本效益。最后,我们评估正在出现的治疗方法,这些方法缩小了CF患者群体中的死亡率差距。未来,直接针对CFTR的药理学增强剂和校正剂对CFRD和更广泛的CF患者群体都显示出巨大的前景。