Cystic fibrosis‐related diabetes mellitus: clinical impact of prediabetes and effects of insulin therapy*

Abstract

The clinical status of CF patients who will need insulin therapy deteriorates before the start of insulin. In patients with CF-related diabetes, with or without fasting hyperglycaemia, insulin therapy improves anabolism and provides good glycaemic control with few severe hypoglycaemic episodes.

Increased glucose excursion in cystic fibrosis and its association with a worse clinical status

“…These observations are somewhat different than those in the literature where diabetes was predictive of a worse pulmonary function degradation and an increased mortality rate [33]. It was also shown that the treatment of diabetes in these patients was associated with an improvement in the clinical status [34][35][36]. It is possible that this strong association is due to the fact that these studies included long standing CFRD, frequently presenting confounding factors such as malnutrition and infection [17,33,37,38].…”

Use of continuous subcutaneous insulin infusion in patients with cystic fibrosis related diabetes: Three case reports

“…Patients with CFRD report an increased risk of hypoglycemia (as a consequence of their impaired counter-regulatory function or poor glucagon response [5,16]). In our patients, the improvement in glycaemic control during the CSII treatment did not lead to increase in severe hypoglycaemic events.…”

“…DM in CF exhibits different clinical characteristics in comparison with type 1 and type 2 diabetes [4]. As this is an insulinopenic condition, at present, insulin treatment is the only medical therapy officially recommended for CFRD [5]. Good glycometabolic control is important not only to improve the clinical and nutritional status of these patients, but also to prevent or delay the appearance of long-term microvascular complications linked to the diabetic disease [6,7].…”

Clinical importance of cystic fibrosis-related diabetes

“…Clinical status and pulmonary function decline 2-4 years prior to the diagnosis of CFRD with FH, perhaps due to progressive glucose intolerance. Pre-diabetic pulmonary and clinical decline can be reversed with insulin, suggesting a role for early initiation of therapy as glucose intolerance develops [54,78]. Insulin therapy also reversed decline in lung function and weight loss in four people with long standing CF who had normal glucose tolerance on OGTT, but intermittent abnormal random blood glucose concentrations [79].…”