Once daily insulin detemir in cystic fibrosis with insulin deficiency

Abstract

The aim of this study was to determine if once daily insulin detemir reverses decline in weight and lung function in patients with cystic fibrosis (CF). 12 patients with early insulin deficiency and six with CF related diabetes (aged 7.2-18.1 years) were treated for a median of 0.8 years. Changes in weight and lung function following treatment were compared to pretreatment changes. Before treatment, the change in weight SD score (ΔWtSDS), percentage of predicted forced expiratory volume in 1 s (Δ%FEV(1)) and percentage of predicted forced vital capacity (Δ%FVC) declined in the whole study population (-0.45±0.38, -7.9±12.8%, -5.8±14.3%) and in the subgroup with early insulin deficiency (-0.41±0.43, -9.8±9.3%, -6.8±10.3%). Following treatment with insulin ΔWtSDS, Δ%FEV(1) and Δ%FVC significantly improved in the whole study population (+0.18±0.29 SDS, p=0.0001; +3.7±10.6%, p=0.007; +5.2±12.7%, p=0.013) and in patients with early insulin deficiency (+0.22±0.31 SDS, p=0.003; +5.3±11.5%, p=0.004; +5.8±13.4%, p=0.024). Randomised controlled trials are now needed.

Insulin therapy in patients with cystic fibrosis in the pre-diabetes stage: a systematic review

“…However, in the study by Minicucci et al16 there was a 10% decrease in FEV1 in the year prior to the intervention, which may be a bias because even CFRD patients have no such decline in this parameter. Koloušková et al17 and Drummond et al12 , who had a more consistent number of cases, found that FEV1 was lower in the untreated group compared to those treated with insulin, which confirms the results described by Dobson et al6 Bizarri et al20 , and Hameed et al19 …”

“…Bizzarri et al,20 Mozzillo et al,18 and Hameed et al19 found a significant increase in FEV1 after the use of insulin. Koloušková et al17 found that, at the end of follow-up, intervention group had higher FEV1 compared to control group.…”

“…Exclusion criteria for this study were: (I) use of oral or intravenous corticosteroids in the last six months; (II) fasting hyperglycemia in the previous year; (III) liver dysfunction; (IV) pregnancy. Early insulin deficiency, diagnosed by intravenous glucose tolerance test (IVGTT) and/or high levels of glucose in OGTT, was used as inclusion criteria in the studies by Koloušková et al17 and Hameed et al19 …”

“…Mozzillo et al18 reported increased FEV1 and reduced pulmonary exacerbations with the use of insulin. Hameed et al19 demonstrated a fall in FEV1 before starting treatment and improvement after the introduction of insulin. Koloušková et al17 and Drummond et al12 assessed FEV1 compared to untreated subjects and identified a decline in lung function in control group, which was not seen in insulin-treated group.…”

Screening for cystic fibrosis-related diabetes: a systematic review.

“…This before-and-after study 161 looked at the effect of a single daily dose of insulin detemir on weight change and lung function in six patients with CFRD and 12 with 'early insulin deficiency' , defined by peak BG level during OGTT but with a 2-hour level of < 11.1 mmol/l. The median age of the patients was 12.5 years, and all but one had exocrine pancreatic insufficiency.…”