Kutney Katherine, Kaminski Beth A, Casey Terri, O'Riordan MaryAnn, Gubitosi-Klug Rose
Case Western Reserve University, Cleveland OH, United States.
University Hospitals Rainbow Babies and Children's Hospital, Cleveland OH, United States.
J Clin Transl Endocrinol. 2023 Aug 25;33:100323. doi: 10.1016/j.jcte.2023.100323. eCollection 2023 Sep.
Cystic fibrosis related diabetes (CFRD) is associated with insulin-remediable pulmonary decline, so early detection is critical. Continuous glucose monitors (CGM) have shown promise in screening but are not recommended by clinical practice guidelines. Little is known about the reproducibility of CGM results for a given patient.
Twenty non-insulin treated adults and adolescents with CF placed an in-home CGM and wore it for two 14-day periods. Participants underwent a mixed meal tolerance test (MMTT) on day 5 of each 14-day period. Glycemic data from CGM 1 and CGM 2 were compared regarding published thresholds to define abnormality: percent time >140 mg/dL of ≥4.5%, percent time >140 mg/dL of >17.5%, and percent time >180 mg/dL of >3.4%. Results of the repeat MMTT were compared for peak glucose and 2-hour glucose thresholds: >140 mg/dL, >180 mg/dL, and >200 mg/dL.
For percent time >140 mg/dL of ≥ 4.5%, five of 20 subjects had conflicting results between CGM 1 and CGM 2. For percent time >140 mg/dL of >17.5% and >180 mg/dL of >3.4%, only one of 20 subjects had conflicting results between CGM 1 and CGM 2. On the MMTT, few participants had a 2-hour glucose >140 mg/dL. Peak glucose >140 mg/dL, 180 mg/dL, and 200 mg/dL were more common, with 10-37% of participants demonstrating disagreement between CGM 1 and CGM 2.
Repeated in-home CGM acquisitions show reasonable reproducibility regarding the more stringent thresholds for time >140 mg/dL and >180 mg/dL. More data is needed to determine thresholds for abnormal mixed meal tolerance tests in CFRD screening.
囊性纤维化相关糖尿病（CFRD）与胰岛素可纠正的肺部功能下降有关，因此早期检测至关重要。连续血糖监测仪（CGM）在筛查中显示出前景，但临床实践指南未推荐使用。对于给定患者，CGM结果的可重复性知之甚少。
20名未接受胰岛素治疗的成年和青少年囊性纤维化患者在家中佩戴CGM，并佩戴两个14天周期。参与者在每个14天周期的第5天进行混合餐耐量试验（MMTT）。比较CGM 1和CGM 2的血糖数据与已公布的定义异常的阈值：血糖>140mg/dL的时间百分比≥4.5%、血糖>140mg/dL的时间百分比>17.5%以及血糖>180mg/dL的时间百分比>3.4%。比较重复MMTT的峰值血糖和2小时血糖阈值结果：>140mg/dL、>180mg/dL和>200mg/dL。
对于血糖>140mg/dL的时间百分比≥4.5%，20名受试者中有5名在CGM 1和CGM 2之间结果不一致。对于血糖>140mg/dL的时间百分比>17.5%以及血糖>180mg/dL的时间百分比>3.4%，20名受试者中只有1名在CGM 1和CGM 2之间结果不一致。在MMTT中，很少有参与者2小时血糖>140mg/dL。峰值血糖>140mg/dL、180mg/dL和200mg/dL更为常见，10%-37%的参与者在CGM 1和CGM 2之间存在差异。
在家中重复进行CGM采集对于血糖>140mg/dL和>180mg/dL的更严格时间阈值显示出合理的可重复性。需要更多数据来确定CFRD筛查中异常混合餐耐量试验的阈值。
