Ahmed Ammar, Ankireddypalli Anvitha, Harindhanavudhi Tasma, Moran Antoinette, Moheet Amir
Division of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
J Clin Transl Endocrinol. 2024 Nov 7;38:100375. doi: 10.1016/j.jcte.2024.100375. eCollection 2024 Dec.
Cystic fibrosis-related diabetes (CFRD) is the most common non-pulmonary comorbidity in people with cystic fibrosis (CF). Current guidelines recommend insulin therapy as the treatment of choice for people with CFRD. In the past, obesity and overweight were uncommon in individuals with CF. However, in recent years, advancements in CF therapies have led to a significant increase in the prevalence of overweight and obesity within this population. Glucagon-like peptide1 receptor agonist (GLP-1 RA) therapies could potentially improve glycemic control in people with CF by increasing insulin secretion, slowing gastric emptying, and promoting weight loss through central appetite suppression, which in turn can enhance insulin sensitivity. We report, for the first time, five cases of individuals with CFRD complicated by obesity treated with GLP 1-RA for at least two years. With GLP 1-RA therapy, 4 out of 5 individuals exhibited weight reduction ranging from 7% to 19% over two years, while forced expiratory volume in 1 s (FEV1)/predicted FEV1 % remained stable or improved in all cases. The impact on glycemic control was variable. Insulin requirements either reduced or remained stable in all five cases. Overall, GLP-1 RA was well tolerated in this case series; one individual discontinued the medication after two years of therapy due to poor appetite and nausea.
囊性纤维化相关糖尿病(CFRD)是囊性纤维化(CF)患者中最常见的非肺部合并症。目前的指南推荐胰岛素治疗作为CFRD患者的首选治疗方法。过去,CF患者中肥胖和超重并不常见。然而,近年来,CF治疗方法的进步导致该人群中超重和肥胖的患病率显著增加。胰高血糖素样肽1受体激动剂(GLP-1 RA)疗法可能通过增加胰岛素分泌、减缓胃排空以及通过中枢性食欲抑制促进体重减轻来改善CF患者的血糖控制,进而增强胰岛素敏感性。我们首次报告了5例CFRD合并肥胖且接受GLP-1 RA治疗至少两年的患者。接受GLP-1 RA治疗后,5例患者中有4例在两年内体重减轻了7%至19%,而所有病例的1秒用力呼气量(FEV1)/预测FEV1%保持稳定或有所改善。对血糖控制的影响各不相同。所有5例患者的胰岛素需求量均减少或保持稳定。总体而言,该病例系列中GLP-1 RA耐受性良好;1例患者在治疗两年后因食欲不佳和恶心而停药。