Gojsina Bojana, Minic Predrag, Todorovic Sladjana, Soldatovic Ivan, Sovtic Aleksandar
Department of Pulmonology, The Institute for Health Protection of Mother and Child Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Front Pediatr. 2021 Jul 9;9:659728. doi: 10.3389/fped.2021.659728. eCollection 2021.
We evaluated the impact of cystic fibrosis-related diabetes (CFRD) on lung disease and nutritional status. The retrospective cohort study evaluated the subjects' medical records from 2004 to 2019. All participants older than 10 years diagnosed by a 30-minutely sampled OGTT formed OGTT-CFRD subgroup. The participants diagnosed with continuous glucose monitoring (CGM) (at least two peaks above 11.1 mmol/l and more than 10% of recorded time above 7.8 mmol/l) formed a CFRD-CGM subgroup. The participants without CFRD formed a non-CFRD group. The longitudinal follow-up was made 2 years before and 3 years after insulin therapy initiation. Of 144 participants included, aged 10-55 years (44% males), 28 (19.4%) had CFRD. The HbA1c was significantly lower in the CGM-CFRD in comparison to the OGTT-CFRD subgroup (5.9 ± 0.62 and 7.3 ± 1.7% respectfully; = 0.04). Subjects with CFRD were malnourished in comparison to non-CFRD, with significant improvements with insulin replacement therapy in regard to BMI Z-score (-1.4 ± 1.3 vs. -0.5 ± 1.2%, = 0.04) and pulmonary exacerbation score ( = 0.02). In OGTT-CFRD subgroup there is an increase in FEV1 (62.7 ± 26.3 to 65.1 ± 21.7%, = 0.7) and decrease in FVC (from 76.4 ± 24.2 to 71.2 ± 20%, = 0.003) from diagnosis to second year of follow-up. In CGM-CFRD subgroup there was a decrease in FEV1 (from 58.2 ± 28.2 to 52.8 ± 25.9%, = 0.2) and FVC-values (from 72.4 ± 26.5 to 67.4 ± 29.1%, = 0.08).Chronic infection was more prevalent in the CFRD group ( = 0.003). Continuous glucose monitoring is a useful tool for insight of glucose impairment and diagnosis of CFRD. Early recognition of CFRD and therapeutic intervention has favorable effects on clinical course of the disease.
我们评估了囊性纤维化相关糖尿病（CFRD）对肺部疾病和营养状况的影响。这项回顾性队列研究评估了2004年至2019年受试者的病历。所有年龄超过10岁且通过30分钟采样的口服葡萄糖耐量试验（OGTT）确诊的参与者组成OGTT-CFRD亚组。通过持续葡萄糖监测（CGM）确诊（至少两个峰值高于11.1 mmol/l且记录时间超过10%高于7.8 mmol/l）的参与者组成CFRD-CGM亚组。没有CFRD的参与者组成非CFRD组。在开始胰岛素治疗前2年和治疗后3年进行纵向随访。纳入的144名参与者年龄在10 - 55岁之间（44%为男性），其中28名（19.4%）患有CFRD。与OGTT-CFRD亚组相比，CGM-CFRD亚组的糖化血红蛋白（HbA1c）显著更低（分别为5.9±0.62%和7.3±1.7%；P = 0.04）。与非CFRD参与者相比，CFRD参与者存在营养不良，胰岛素替代治疗后在体重指数Z评分方面有显著改善（-1.4±1.3对-0.5±1.2%，P = 0.04），肺部加重评分也有改善（P = 0.02）。在OGTT-CFRD亚组中，从诊断到随访第二年，第一秒用力呼气容积（FEV1）有所增加（从62.7±26.3%增至65.1±21.7%，P = 0.7），用力肺活量（FVC）有所下降（从76.4±24.2%降至71.2±20%，P = 0.003）。在CGM-CFRD亚组中，FEV1有所下降（从58.2±28.2%降至52.8±25.9%，P = 0.2），FVC值也有所下降（从72.4±26.5%降至67.4±29.1%，P = 0.08）。慢性感染在CFRD组中更为普遍（P = 0.003）。持续葡萄糖监测是了解葡萄糖损害和诊断CFRD的有用工具。早期识别CFRD并进行治疗干预对疾病的临床进程有积极影响。
