Early Detection of Impaired Glucose Tolerance in Patients with Cystic Fibrosis and Predisposition Factors

Garagorri, Jesus-Maria; Rodríguez, Germán Vicente; Ros, Lucia Da; Sánchez, Antonio Ruiz

doi:10.1515/jpem.2001.14.1.53

Cited by 21 publications

(17 citation statements)

References 23 publications

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“…Similar results were obtained with the intravenous glucose tolerance test (IVGTT) technique (23,39,(42)(43)(44). Both methods are unsuitable for large-scale and repeated assessment.…”

Section: Introductionsupporting

confidence: 64%

Identification of insulin secretory defects and insulin resistance during oral glucose tolerance test in a cohort of cystic fibrosis patients

Battezzati

Mari

Zazzeron

et al. 2011

European Journal of Endocrinology

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Background: Cystic fibrosis (CF)-related diabetes is a leading complication of CF and is associated with pulmonary and nutritional deterioration, years before an evident hyperglycemia, possibly because of insulin deficiency and resistance. Aim: To evaluate glucose tolerance, insulin secretion, and insulin sensitivity by a widely applicable method suitable for accurate and prospective measurements in a CF population. Methods: A total of 165 CF subjects (80 females) aged 17G5 years and 18 age-and sex-matched healthy controls (CON) received an oral glucose tolerance test with glucose, insulin and C-peptide determinations. Insulin sensitivity was defined on the basis of glucose and insulin concentrations using the oral glucose insulin sensitivity index, whereas b-cell function was determined on the basis of a model relating insulin secretion (C-peptide profile) to glucose concentration. Results: Fifteen percent of CF patients had glucose intolerance and 6% had diabetes without fasting hyperglycemia and 3% had diabetes with fasting hyperglycemia. b-cell function was reduced in CF patients compared with CON (70.0G4.1 vs 117.9G11.6 pmol/min per m 2 per mM, P!0.001) and decreased significantly with age by K2.7 pmol/min per m 2 per mM per year (confidence interval (CI) K4.5 to K0.82), i.e. almost 4% yearly. The early insulin secretion index was also reduced. Insulin sensitivity was similar to CON. CF patients who attained glucose tolerance comparable to CON had lower b-cell function and higher insulin sensitivity. Conclusion: The major alteration in insulin secretion and insulin sensitivity of CF patients is slowly declining b-cell function, consisting of delayed and reduced responsiveness to hyperglycemia, that in CF patients with normal glucose tolerance may be compensated by an increased insulin sensitivity.

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“…Similar results were obtained with the intravenous glucose tolerance test (IVGTT) technique (23,39,(42)(43)(44). Both methods are unsuitable for large-scale and repeated assessment.…”

Section: Introductionsupporting

confidence: 64%

Identification of insulin secretory defects and insulin resistance during oral glucose tolerance test in a cohort of cystic fibrosis patients

Battezzati

Mari

Zazzeron

et al. 2011

European Journal of Endocrinology

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“…Glucose intolerance was strongly associated with pancreatic insufficiency. 31,32 Milla et al 13 followed 152 patients with CF over 4 years and found a higher prevalence of impaired glucose tolerance than in our study. At baseline, 45% of their patients * Multivariate analysis of variance with sex and glucose-tolerance group as fixed factors.…”

Section: Discussionsupporting

confidence: 48%

Glucose Intolerance in Patients With Cystic Fibrosis: Sex-Based Differences in Clinical Score, Pulmonary Function, Radiograph Score, and 6-Minute Walk Test

et al. 2011

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OBJECTIVE:To determine the sex-specific relationships between glucose intolerance and Shwachman-Kulczycki clinical score, lung function, Brasfield chest-radiograph score, and exercise capacity in patients with cystic fibrosis (CF). METHODS: We used a cross-sectional study design and included CF patients > 10 years old. All patients had clinical and nutritional evaluation, oral glucose tolerance test, spirometry, chest radiograph, and 6-min walk test (6MWT). Patients were classified as having normal glucose tolerance, impaired glucose tolerance, or CF-related diabetes mellitus. RESULTS: We included 88 patients: 59 with normal glucose tolerance, 15 with impaired glucose tolerance, and 14 with CF-related diabetes. Shwachman-Kulczycki clinical score (P ‫؍‬ .04), at-rest S pO 2 (P ‫؍‬ .001), S pO 2 difference before versus after 6MWT (P ‫؍‬ .001), and Brasfield chest-radiograph score (P ‫؍‬ .01) were significantly lower in the impaired-glucose-tolerance group than in the normal-glucosetolerance group, but did not differ from the CF-related-diabetes group. In female patients only, percentof-predicted FEV 1 was significantly lower in the impaired-glucose-tolerance group than in the normalglucose-tolerance group (P ‫؍‬ .02), but did not differ from the CF-related-diabetes group (P ‫؍‬ .10). There was a significant relationship between glucose intolerance and sex when clinical score, 6-min walk distance, FEV 1 , and radiograph score were combined in a multivariate analysis. CONCLUSIONS: In patients with CF, glucose intolerance was associated with poor clinical score, lower at-rest S pO 2 , greater S pO 2 difference before versus after 6MWT, poor lung function, and lower radiograph score. Overall, multivariate analysis indicated poorer performance in the latter variables in female patients with glucose intolerance than in male patients with glucose intolerance.

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“…This document states that nutritional and metabolic consequences of IGT in CF patients are still unknown and thus no specific guidelines for management are given, except for a close follow up to detect the onset of CFRD. However, recent studies pointed towards mild glucose metabolism alterations as a cause of clinical deterioration in patients with CF (23,24).…”

Section: Introductionmentioning

confidence: 99%

Insulin-secretion abnormalities and clinical deterioration related to impaired glucose tolerance in cystic fibrosis

et al. 2005

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Objective: To evaluate insulin-secretion kinetics and insulin sensitivity in cystic fibrosis (CF) patients with normal glucose tolerance (CF-NGT), impaired glucose tolerance (CF-IGT) or CF-related diabetes (CFRD), and the potential effects of moderate hyperglycemia on clinical and nutritional status. Design and methods: Cross-sectional study including 50 outpatients with CF. Patients underwent both oral (OGGT) and intravenous (IVGTT) glucose tolerance tests in order to assess insulin secretion and peripheral insulin sensitivity. Homeostasis assessment model and OGGT were used to investigate insulin sensitivity. Forced expiratory volume in the first second (FEV 1 ) and forced vital capacity (FVC) were measured to evaluate pulmonary function. Body mass index (BMI) was determined to assess nutritional status. Results: Insulin secretion was significantly decreased (and delayed at OGTT) in the CFRD group (n ¼ 9) versus the CF-IGT group (n ¼ 10) and the CF-IGT versus the CF-NGT group (n ¼ 31). Insulin sensitivity was significantly different in the CF-IGT and CFRD groups versus the CF-NGT group. FEV 1 , FVC and BMI presented a significant linear correlation with plasma glucose value at 120 min at OGTT and were significantly lower in both CF-IGT and CFRD versus the CF-NGT group, whereas no differences were found between the CF-IGT and CFRD groups. Conclusions: CF patients with IGT present diminished insulin secretion and increased peripheral insulin resistance, correlating with a worse clinical status, undernutrition and impaired pulmonary function. These findings open the question of whether early treatment of mild alterations of glucose metabolism with insulin secretagogues or short-action insulin may lead to improvement of clinical status in CF patients.European Journal of Endocrinology 152 241-247

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Early Detection of Impaired Glucose Tolerance in Patients with Cystic Fibrosis and Predisposition Factors

Cited by 21 publications

References 23 publications

Identification of insulin secretory defects and insulin resistance during oral glucose tolerance test in a cohort of cystic fibrosis patients

Identification of insulin secretory defects and insulin resistance during oral glucose tolerance test in a cohort of cystic fibrosis patients

Glucose Intolerance in Patients With Cystic Fibrosis: Sex-Based Differences in Clinical Score, Pulmonary Function, Radiograph Score, and 6-Minute Walk Test

Insulin-secretion abnormalities and clinical deterioration related to impaired glucose tolerance in cystic fibrosis

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