Declercq Dimitri, Helleputte Simon, Marchand Sophie, Van Aken Sara, Van Braeckel Eva, Van Daele Sabine, T'Sjoen Guy, Van Biervliet Stephanie, Lapauw Bruno
Department of Pediatrics, Cystic Fibrosis Reference Centre, Ghent University Hospital, Ghent, Belgium; Department of Pediatrics, Centre for Children and Adolescents with Diabetes, Ghent University Hospital, Ghent, Belgium; Centre for Nutrition and Dietetics, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
J Cyst Fibros. 2023 Jan;22(1):59-65. doi: 10.1016/j.jcf.2022.08.016. Epub 2022 Sep 6.
In patients with cystic fibrosis (CF), it is still unclear to which extent glucose abnormalities - preceding the diagnosis of cystic fibrosis related diabetes (CFRD) - are associated with pulmonary and nutritional outcome parameters. This study related circadian glycemic patterns to clinical outcomes in a group of CF patients not previously diagnosed with diabetes.
Continuous glucose monitoring (CGM) readings (7 days) of 47 CF patients (26 children, 21 adults) with an impaired oral glucose tolerance test (OGTT) (n = 25) and/or increased Hb1Ac (> 5.5%) were analyzed. Biometric, pulmonary function and clinical parameters were retrospectively collected over a period of 1 year before (T-1) and 1 year after (T + 1) CGM (T0).
96% (45/47) of CGM readings showed glucose values > 140 mg/dL ≥ 4.5% of the time and at least one ≥ 200 mg/dL. In the pediatric cohort, no significant associations were found between CGM parameters and pulmonary and nutritional outcome parameters. In the adult cohort, an area under the curve (AUC) > 140 mg/dL and%-time > 140 mg/dL during the night were associated with a lower forced expiratory volume in 1 s (FEV1)% predicted (pp) at time of evaluation but not with change in FEV1pp.
This is the first study reporting the circadian glycemic pattern in children and adults at risk for CFRD. In the adult cohort an association between detection of abnormal glucose exposure and a lower FEV1pp was found. Our results support continued screening for glucose intolerance in patients with CF.
在囊性纤维化（CF）患者中，在囊性纤维化相关糖尿病（CFRD）诊断之前，血糖异常在多大程度上与肺部和营养结局参数相关仍不清楚。本研究将一组先前未诊断出糖尿病的CF患者的昼夜血糖模式与临床结局相关联。
分析了47例口服葡萄糖耐量试验（OGTT）受损（n = 25）和/或Hb1Ac升高（> 5.5%）的CF患者（26名儿童，21名成人）的连续血糖监测（CGM）读数（7天）。回顾性收集了CGM（T0）前1年（T-1）和后1年（T + 1）期间的生物特征、肺功能和临床参数。
96%（45/47）的CGM读数显示血糖值> 140 mg/dL的时间≥4.5%，且至少有一次≥200 mg/dL。在儿科队列中，未发现CGM参数与肺部和营养结局参数之间存在显著关联。在成人队列中，夜间曲线下面积（AUC）> 140 mg/dL和血糖值> 140 mg/dL的时间百分比与评估时预测的1秒用力呼气量（FEV1）%相关，但与FEV1预测值百分比的变化无关。
这是第一项报告有CFRD风险的儿童和成人昼夜血糖模式的研究。在成人队列中，发现异常葡萄糖暴露检测与较低的FEV1预测值百分比之间存在关联。我们的结果支持继续对CF患者进行葡萄糖不耐受筛查。
