Rakotoarisoa Luc, Weiss Laurence, Lefebvre François, Porzio Michele, Renaud-Picard Benjamin, Ravoninjatovo Bruno, Abely Michel, Danner-Boucher Isabelle, Dubois Séverine, Troussier Françoise, Prevotat Anne, Rault Gilles, Kessler Romain, Kessler Laurence
Department of Endocrinology, Diabetes and Nutrition, Strasbourg University Hospital, France; Adult Cystic Fibrosis Centre, Strasbourg University Hospital, France; UMR Inserm 1260, Regenerative Nanomedicine, University of Strasbourg, France.
Pediatric Cystic Fibrosis Centre, Strasbourg University Hospital, France.
J Diabetes Complications. 2024 Apr;38(4):108703. doi: 10.1016/j.jdiacomp.2024.108703. Epub 2024 Feb 14.
Cystic fibrosis related diabetes (CFRD) is commonly associated with declining lung function and nutritional status. We aimed to evaluate the pulmonary impact of early glucose abnormalities by using 2-h standard oral glucose tolerance testing (OGTT) and continuous glucose monitoring (CGM) in people with cystic fibrosis (PwCF).
PwCF aged ≥10 years old without known CFRD were included in a five-year prospective multicentre study. Annual evaluation of nutritional status, lung function, OGTT and CGM was set up. Associations between annual rate changes (Δ) in lung function, ΔFEV1 (forced expiratory volume in 1 s) percentage predicted (pp) and ΔFVC (forced vital capacity) pp., and annual rate changes in OGTT or CGM variables were estimated with a mixed model with a random effect for subject.
From 2009 to 2016, 112 PwCF (age: 21 ± 11 years, BMI (body mass index) z-score: -0.55 ± 1.09, FEV1pp: 77 ± 24 %, 2-h OGTT glucose: 122 ± 44 mg/dL, AUC (area under curve) >140 mg/dL: 1 mg/dL/day (0.2, 3.0) were included. A total of 428 OGTTs and 480 CGMs were collected. The participants presented annual decline of FVCpp and FEV1pp at -1.0 % per year (-1.6, -0.4), p < 0.001 and - 1.9 % per year (-2.5, -1.3), p < 0.001 respectively without change in BMI z-score during the study. Variation of two-hour OGTT glucose was not associated with declining lung function, as measured by ΔFEV1pp (p = 0.94) and ΔFVCpp (p = 0.90). Among CGM variables, only increase in AUC >140 mg/dL between two annual visits was associated with a decrease in ΔFVCpp (p < 0.05) and ΔFEV1pp (p < 0.05).
This prospective study supports the fact that early glucose abnormalities revealed by CGM predict pulmonary function decline in PwCF, while 2-h standard OGTT glucose is not associated with pulmonary impairment.
囊性纤维化相关糖尿病（CFRD）通常与肺功能和营养状况下降有关。我们旨在通过对囊性纤维化患者（PwCF）进行2小时标准口服葡萄糖耐量试验（OGTT）和持续葡萄糖监测（CGM）来评估早期血糖异常对肺部的影响。
年龄≥10岁且无已知CFRD的PwCF纳入一项为期五年的前瞻性多中心研究。建立了对营养状况、肺功能、OGTT和CGM的年度评估。使用具有受试者随机效应的混合模型估计肺功能年变化率（Δ）、预测的1秒用力呼气容积（FEV1）变化率百分比（pp）和用力肺活量（FVC）变化率pp与OGTT或CGM变量年变化率之间的关联。
2009年至2016年，纳入112例PwCF（年龄：21±11岁，体重指数（BMI）z评分：-0.55±1.09，FEV1pp：77±24%，2小时OGTT血糖：122±44mg/dL，曲线下面积（AUC）>140mg/dL：1mg/dL/天（0.2，3.0））。共收集428次OGTT和480次CGM数据。研究期间，参与者的FVCpp和FEV1pp每年分别下降-1.0%（-1.6，-0.4），p<0.001和-1.9%（-2.5，-1.3），p<0.001，而BMI z评分无变化。通过ΔFEV1pp（p=0.94）和ΔFVCpp（p=0.90）测量，2小时OGTT血糖的变化与肺功能下降无关。在CGM变量中，仅两次年度就诊之间AUC>140mg/dL的增加与ΔFVCpp（p<0.05）和ΔFEV1pp（p<0.05）的降低相关。
这项前瞻性研究支持以下事实，即CGM显示的早期血糖异常可预测PwCF的肺功能下降，而2小时标准OGTT血糖与肺损伤无关。
