Cystic Fibrosis-Related Diabetes Screening in Adults: A Gap Analysis and Evaluation of Accuracy of Glycated Hemoglobin Levels

Gilmour, Julie; Sykes, Jenna; Etchells, Edward; Tullis, Elizabeth

doi:10.1016/j.jcjd.2018.04.008

Cited by 35 publications

(13 citation statements)

References 23 publications

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“…The recent study of Gilmour et al has demonstrated an alternative approach for CFRD screening in order to reduce the need for OGTT. Introducing the cutoff HbA1c value of 5.5% (36.6 mmol/mol) as an indicator for the need for further screening with OGTT could be an attractive method but has not yet been validated for the pediatric population [29] . In our study all but one of the NGT participants had their HbA1c level below this cutoff point which is promising but the cohort is too small to make any concrete assumptions.…”

Section: Discussionmentioning

confidence: 99%

Abnormal glucose tolerance and lung function in children with cystic fibrosis. Comparing oral glucose tolerance test and continuous glucose monitoring

Elidottir

Diemer

Eklund

et al. 2021

Journal of Cystic Fibrosis

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Background: Cystic fibrosis (CF) related diabetes (CFRD) is a common complication of CF. CFRD is associated with declining lung function even before its onset. Regular screening for CFRD using oral glucose tolerance test (OGTT) is recommended. Additionally, continuous glucose monitoring (CGM) has surfaced as a possible surveillance method, but evidence for its use and concordance with OGTT has not been established. Methods: Children were prospectively recruited at CF center Lund to undergo both intermittent scan CGM (isCGM) and OGTT. Lung function was evaluated by spirometry and multiple breath washout. Demographic and clinical data were collected from the Swedish national CF registry. Results: 32 patients participated in the study, yielding 28 pairs of isCGMs and OGTTs. The OGTTs showed that two patients met the criteria of CFRD, seven had impaired glucose tolerance (IGT) and indeterminate glycemia (INDET) was found in eleven cases. The isCGM percent of measurements > 8mmol/L and the number of peaks per day > 11 mmol/L have correlations with intermediate OGTT glucose time points, but not the 2hour glucose value. Patients with abnormal glucose tolerance (AGT) had lower lung function than those with normal glucose tolerance demonstrated by both FEV1% predicted and lung clearance index (LCI). Conclusion: Correlations can be found between isCGM and OGTT in regards to the latter's intermediate time points. LCI demonstrates as well as FEV1% of predicted, worse lung function in children and adolescents with abnormal glucose tolerance in CF.

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Section: Discussionmentioning

confidence: 99%

Abnormal glucose tolerance and lung function in children with cystic fibrosis. Comparing oral glucose tolerance test and continuous glucose monitoring

Elidottir

Diemer

Eklund

et al. 2021

Journal of Cystic Fibrosis

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“…Although A1C is not recommended for diagnosis of diabetes in children with cystic fibrosis or symptoms suggestive of acute onset of type 1 diabetes and only A1C assays without interference are appropriate for children with hemoglobinopathies, the ADA continues to recommend A1C for diagnosis of type 2 diabetes in this cohort (74,75). however, recent publications suggest that an A1C cut point lower than 5.4% (5.8% in a second study) would detect more than 90% of cases and reduce patient screening burden (77,78). Ongoing studies are underway to validate this approach.…”

Section: Screening and Testing For Prediabetes And Type 2 Diabetes In Children And Adolescentsmentioning

confidence: 97%

“…Ongoing studies are underway to validate this approach. Regardless of age, weight loss or failure of expected weight gain is a risk for CFRD and should prompt screening (77,78). Continuous glucose monitoring or HOMA of b-cell function ( 79) may be more sensitive than OGTT to detect risk for progression to CFRD; however, evidence linking these results to long-term outcomes is lacking, and these tests are not recommended for screening (80).…”

Section: Screening and Testing For Prediabetes And Type 2 Diabetes In Children And Adolescentsmentioning

confidence: 99%

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2020

2019

Diabetes Care

2,446

1,236

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CLASSIFICATION AND DIAGNOSIS OF DIABETESc Autoimmunity c Dysglycemia c Presymptomatic c New-onset hyperglycemia c Symptomatic Diagnostic criteria c Multiple autoantibodies c No IGT or IFG c Multiple autoantibodies c Dysglycemia: IFG and/or IGT c FPG 100-125 mg/dL (5.6-6.9 mmol/L) c 2-h PG 140-199 mg/dL (7.8-11.0 mmol/L) c A1C 5.7-6.4% (39-47 mmol/mol) or $10% increase in A1C c Clinical symptoms c Diabetes by standard criteria care.diabetesjournals.org Classification and Diagnosis of Diabetes S15 S16 Classification and Diagnosis of Diabetes

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“…The inconvenience of OGTT may contribute to poor patient uptake of CFRD screening [98][99][100]. In 2018, the Cystic Fibrosis Foundation Patient Registry reported that the average CF center was screening just 61.3% of adolescents and 32.8% of adults [100].…”

Section: Oral Glucose Tolerance Testingmentioning

confidence: 99%

Detection and Management of Early Glucose Abnormalities in Cystic Fibrosis

Theocharous¹,

Prentice²,

Verge³

et al. 2021

Cystic Fibrosis - Facts, Management and Advances

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With advances in technology, it is now possible to detect the emergence of glucose abnormalities in cystic fibrosis with improved sensitivity, and from a very early age. These abnormalities are increasingly recognized as predictors of clinical decline, raising the possibility that early intervention may slow or prevent this deterioration. In this chapter, we will review the available literature on methods of detecting glucose abnormalities in cystic fibrosis (random and fasting glucose, HbA1c, oral glucose tolerance testing, and continuous glucose monitoring), and detail their advantages and possible limitations in the interpretation of glycemic data. We will also discuss treatment outcomes of early intervention, prior to the diagnosis of diabetes as currently defined.

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Cystic Fibrosis-Related Diabetes Screening in Adults: A Gap Analysis and Evaluation of Accuracy of Glycated Hemoglobin Levels

Abstract: The rate of CFRD screening is suboptimal. An alternative screening algorithm using an A1C threshold of 5.5% has the potential to reduce the requirement for OGTTs by 36.7%. A1C levels cannot be used to identify impaired glucose tolerance.

Cited by 35 publications

References 23 publications

Abnormal glucose tolerance and lung function in children with cystic fibrosis. Comparing oral glucose tolerance test and continuous glucose monitoring

Abnormal glucose tolerance and lung function in children with cystic fibrosis. Comparing oral glucose tolerance test and continuous glucose monitoring

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2020

Detection and Management of Early Glucose Abnormalities in Cystic Fibrosis

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