Montreal Clinical Research Institute, Montréal, Québec, Canada; Division of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada.
Montreal Clinical Research Institute, Montréal, Québec, Canada.
Can J Diabetes. 2022 Apr;46(3):294-301.e2. doi: 10.1016/j.jcjd.2021.11.004. Epub 2021 Dec 10.
The clinical relevance of fasting and postprandial hypoglycemia in patients with cystic fibrosis (CF) is poorly characterized. Our aim in this study was to characterize the prevalence of hypoglycemia in adult patients during oral glucose tolerance test (OGTT) screening and determine its impact on the risk of developing CF-related diabetes (CFRD).
We analyzed 2 cohorts of pancreatic insufficient patients with CF exposed to comparable treatment recommendations in France (Lyon CF cohort [DIAMUCO]) and Canada (Montréal CF cohort [MCFC]). Patients were classified into 3 groups based on hypoglycemia absence or presence as well as its severity at baseline. We defined the groups as follows: level 2 hypoglycemia (L2H; plasma glucose [PG]<3.0 mmol/L), level 1 hypoglycemia (L1H; PG 3.0 to <4.0 mmol/L) and no hypoglycemia (NH) during an OGTT.
A total of 153 MCFC and 114 DIAMUCO subjects were included in the study. In total, 22% of the patients experienced hypoglycemia, with 5% having it on 2 or more OGTTs. The L1H and L2H groups tended to have a lower 2-hour glucose and higher early-phase insulin secretion (insulin area under the curve at 0 to 30 minutes) compared with NH patients. In both cohorts, a greater proportion of men and patients with normal glucose tolerance had hypoglycemia. Over a 5-year period, there were no cases of CFRD in the L2H group, whereas 4 subjects in the L1H group and 36 in the NH group developed CFRD.
Patients with hypoglycemia were at lower risk of developing CFRD, but at higher risk of early-phase insulin secretion and unsuppressed insulin secretion. This could potentially lead to further hypoglycemia after the 2-hour OGTT, suggesting high clinical relevance.
囊性纤维化（CF）患者空腹和餐后低血糖的临床相关性尚未明确。本研究旨在明确口服葡萄糖耐量试验（OGTT）筛查中成年 CF 患者低血糖的发生率，并确定其对 CF 相关糖尿病（CFRD）发病风险的影响。
我们分析了法国里昂 CF 队列（DIAMUCO）和加拿大蒙特利尔 CF 队列（MCFC）中接受相似治疗推荐的 2 组胰腺功能不全 CF 患者。根据基线时是否存在低血糖及其严重程度，将患者分为 3 组。我们将这些组定义为：2 级低血糖（L2H；血糖[PG]<3.0mmol/L）、1 级低血糖（L1H；PG 3.0 至<4.0mmol/L）和 OGTT 期间无低血糖（NH）。
共有 153 例 MCFC 和 114 例 DIAMUCO 患者纳入本研究。共有 22%的患者发生低血糖，其中 5%的患者在 2 次或以上 OGTT 中出现低血糖。与 NH 患者相比，L1H 和 L2H 组的 2 小时血糖较低，早期胰岛素分泌较高（0 至 30 分钟时胰岛素曲线下面积）。在两个队列中，更多的男性和糖耐量正常的患者发生低血糖。在 5 年期间，L2H 组无 CFRD 病例，而 L1H 组有 4 例和 NH 组有 36 例发展为 CFRD。
有低血糖的患者发生 CFRD 的风险较低，但发生早期胰岛素分泌和未被抑制的胰岛素分泌的风险较高。这可能导致 2 小时 OGTT 后进一步发生低血糖，提示具有较高的临床相关性。
