Division of Endocrinology and Diabetes, Seattle Children's Hospital, Seattle, WA, USA.
Department of Pediatrics, University of Washington, Seattle, WA, USA.
Endocrinol Diabetes Metab. 2020 Nov 30;4(2):e00208. doi: 10.1002/edm2.208. eCollection 2021 Apr.
Hyperglycaemia may contribute to failure to recover from pulmonary exacerbations in cystic fibrosis (CF). We aimed to evaluate the prevalence and mechanism of hyperglycaemia during and post-exacerbations.
Nine paediatric CF patients, not on insulin, hospitalized for intravenous antibiotics, underwent an oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM) upon admission (visit 1) and an OGTT 2 weeks (visit 2) and 6 weeks to 12 months later when at stable baseline (visit 3). Insulin and glucose levels were measured before, 30, 60 and 120 min after glucose ingestion during OGTT. Hyperglycaemia on OGTT was defined according to the American Diabetes Association criteria as abnormal OGTT or consistent with diabetes. Hyperglycaemia on CGM was defined as CGM time above 140 mg/dL > 4.5%.
At visit 1, 8/9 patients had hyperglycaemia on both CGM and OGTT (2 diabetes and 6 abnormal OGTT). At visit 2, 5/8 had hyperglycaemia (all abnormal OGTT). At visit 3, (median (IQR) time since visit 1, 4.9 (3.8-6.3) months), 5/7 had hyperglycaemia (2 diabetes and 3 abnormal OGTT). At visits 1, 2 and 3, respectively, mean (SD) 2-hour OGTT glucose was 175.8 (42.3), 146.3 (31.9) and 176.9 (51.7) mg/dL. CGM time above 140 mg/dL at visit 1 was 25.3% (16.9). Insulin AUC decreased from visit 2 (median (IQR) 5449 (3321-8123) mcIU-min/mL) to visit 3 (3234 (2913-3680) mcIU-min/mL).
Hyperglycaemia is prevalent during paediatric CF exacerbations; it appears to improve with exacerbation treatment but to worsen later in association with decreased insulin secretion.
高血糖可能导致囊性纤维化（CF）患者的肺部恶化无法恢复。我们旨在评估恶化期间和之后高血糖的患病率和发生机制。
9 名未接受胰岛素治疗的儿科 CF 患者因静脉内抗生素治疗而住院，在入院时（第 1 次就诊）进行口服葡萄糖耐量试验（OGTT）和连续血糖监测（CGM），并在 2 周（第 2 次就诊）和 6 周至 12 个月后在稳定的基线时（第 3 次就诊）进行 OGTT。OGTT 期间，在葡萄糖摄入前、摄入后 30、60 和 120 分钟测量胰岛素和血糖水平。根据美国糖尿病协会的标准，OGTT 异常或符合糖尿病的定义为 OGTT 高血糖。CGM 时间超过 140mg/dL 的时间>4.5%定义为 CGM 高血糖。
在第 1 次就诊时，8/9 名患者的 CGM 和 OGTT 均出现高血糖（2 型糖尿病和 6 名异常 OGTT）。在第 2 次就诊时，8/8 名患者中有 5 名出现高血糖（均为异常 OGTT）。在第 3 次就诊时（第 1 次就诊后的中位数（IQR）时间为 4.9（3.8-6.3）个月），7/7 名患者中有 5 名出现高血糖（2 型糖尿病和 3 名异常 OGTT）。在第 1、2 和 3 次就诊时，2 小时 OGTT 葡萄糖的平均值（SD）分别为 175.8（42.3）、146.3（31.9）和 176.9（51.7）mg/dL。第 1 次就诊时 CGM 时间超过 140mg/dL 的时间为 25.3%（16.9）。胰岛素 AUC 从第 2 次就诊（中位数（IQR）5449（3321-8123）mcIU-min/mL）下降到第 3 次就诊（3234（2913-3680）mcIU-min/mL）。
在儿科 CF 恶化期间，高血糖很常见；它似乎随着恶化治疗而改善，但随着胰岛素分泌减少，后来会恶化。
