Importance of screening with oral glucose tolerance test for early diagnosis of cystic fibrosis-related diabetes mellitus

Abstract

The prevalence of CFRD in our patients is high, similar to the data from Caucasian populations, and significantly higher than previously reported in Brazil. Screening with OGTT resulted in earlier diagnosis of CFRD by 8 yr. These data may help convince national CF centers that CFRD is frequent, and that screening should be mandatory.

Hypoglycemia is common in children with cystic fibrosis and seen predominantly in females

“…As the lifespan of patients with CF continues to increase, comorbid conditions appear with age—particularly cystic fibrosis‐related diabetes (CFRD). CFRD is the most common comorbidity in CF patients, with a frequency and incidence of approximately 20% and 12%‐14% in adolescents, respectively and screening with oral glucose tolerance test (OGTT) resulted in earlier diagnosis of CFRD than diagnosed by clinical suspicion . Therefore, it is recommended by ISPAD to screen all CF patients aged >10 years for CFRD annually via the OGTT .…”

“…CFRD is the most common comorbidity in CF patients, with a frequency and incidence of approximately 20% and 12%-14% in adolescents, respectively 1,2 and screening with oral glucose tolerance test (OGTT) resulted in earlier diagnosis of CFRD than diagnosed by clinical suspicion. 3 Therefore, it is recommended by ISPAD to screen all CF patients aged >10 years for CFRD annually via the OGTT. 4 Furthermore, fasting and/or reactive hypoglycemia (RHypo) in OGTT has been reported in adult CF patients recently, with a frequency of 7%-15% in 2-hour OGTT and 45% in 3-hour OGTT.…”

Cystic-fibrosis related-diabetes (CFRD) is preceded by and associated with growth failure and deteriorating lung function

“…Worsening of glucose metabolism leads to increased bacterial growth in the lungs and thus infections of the airways, which limit lung function and life expectancy [5][6][7]. Hence, early recognition and treatment of an altered glucose tolerance is of clinical relevance [3,8,9]. Although more prospective studies are needed to address a possible advantage of insulin treatment over oral hypoglycaemic agents, there are signs of better glycaemic control and improved weight gain when using insulin [10][11][12].…”

Diagnosing cystic fibrosis-related diabetes: current methods and challenges

“…The age of diagnosis has also fallen as the significance of missed or late diagnosis has been recognised. In the Brazilian centre described by Noronha et al the mean age of CFRD diagnosis dropped from 22.3 years to 13.5years (p<0.001) once routine OGTT screening was introduced [73]. In Australia, increased screening has seen a reported increase in the incidence of CFRD from 2.0 to 22.1 per 1000 person-years between 2000 and 2008, which represents a ten-fold increase [74].…”

“…This makes CFRD particularly difficult to diagnose as the latter symptoms of poor growth and lung function may be manifestations of other CF complications such as recurrent chest infections. It has become clear that the prevalence of CFRD may have been historically underestimated prior to the introduction of routine screening [73]. The age of diagnosis has also fallen as the significance of missed or late diagnosis has been recognised.…”