The 1-h oral glucose tolerance test glucose and insulin values are associated with markers of clinical deterioration in cystic fibrosis

Coriati, Adèle; Ziai, S.; Lavoie, Annick; Berthiaume, Yves; Rabasa‐Lhoret, Rémi

doi:10.1007/s00592-015-0791-3

Cited by 30 publications

(32 citation statements)

References 32 publications

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“…Potentially compounding insulin deficiency is impaired suppression of protein catabolism that has been reported at least in the setting of CFRD (25). Indeed lean body mass correlates with pulmonary function in CF, higher 1-h glucose is associated with worse lung function (24), and a lower 1-h insulin is associated with lower BMI% (26). …”

Section: Discussionmentioning

confidence: 99%

Reduced β-Cell Secretory Capacity in Pancreatic-Insufficient, but Not Pancreatic-Sufficient, Cystic Fibrosis Despite Normal Glucose Tolerance

et al. 2016

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Patients with pancreatic-insufficient cystic fibrosis (PI-CF) are at increased risk for developing diabetes. We determined β-cell secretory capacity and insulin secretory rates from glucose-potentiated arginine and mixed-meal tolerance tests (MMTTs), respectively, in pancreatic-sufficient cystic fibrosis (PS-CF), PI-CF, and normal control subjects, all with normal glucose tolerance, in order to identify early pathophysiologic defects. Acute islet cell secretory responses were determined under fasting, 230 mg/dL, and 340 mg/dL hyperglycemia clamp conditions. PI-CF subjects had lower acute insulin, C-peptide, and glucagon responses compared with PS-CF and normal control subjects, indicating reduced β-cell secretory capacity and α-cell function. Fasting proinsulin-to-C-peptide and proinsulin secretory ratios during glucose potentiation were higher in PI-CF, suggesting impaired proinsulin processing. In the first 30 min of the MMTT, insulin secretion was lower in PI-CF compared with PS-CF and normal control subjects, and glucagon-like peptide 1 and gastric inhibitory polypeptide were lower compared with PS-CF, and after 180 min, glucose was higher in PI-CF compared with normal control subjects. These findings indicate that despite “normal” glucose tolerance, adolescents and adults with PI-CF have impairments in functional islet mass and associated early-phase insulin secretion, which with decreased incretin responses likely leads to the early development of postprandial hyperglycemia in CF.

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Section: Discussionmentioning

confidence: 99%

Reduced β-Cell Secretory Capacity in Pancreatic-Insufficient, but Not Pancreatic-Sufficient, Cystic Fibrosis Despite Normal Glucose Tolerance

et al. 2016

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“…For example, patients with CF diagnosed with IGT who have a low BMI and/or low FEV 1 might benefit from further glucose monitoring. Recent research suggests that elevation of 1‐hour plasma glucose during the OGTT is associated with worse lung function . Therefore, it may be beneficial to assess the plasma glucose level at the 1‐hour mark of the OGTT and not just focus on the 2‐hour level .…”

Section: Discussionmentioning

confidence: 99%

“…Recent research suggests that elevation of 1-hour plasma glucose during the OGTT is associated with worse lung function. 25,26 Therefore, it may be beneficial to assess the plasma glucose level at the 1-hour mark of the OGTT and not just focus on the 2-hour level. 26 Additionally, evaluation of continuous glucose monitoring (CGM) demonstrates higher rates of glucose abnormalities than the standard OGTT.…”

Section: Discussionmentioning

confidence: 99%

Impaired glucose tolerance, body mass index and respiratory function in patients with cystic fibrosis: A systematic review

Iwanicki¹,

Logomarsino

2019

Clinical Respiratory J

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Objectives This systematic review aims to evaluate body mass index (BMI) and forced expiratory volume in one second (FEV1) in patients with cystic fibrosis (CF) diagnosed with impaired glucose tolerance (IGT) compared to those with normal glucose tolerance (NGT). The significance of this topic stems from concern that individuals with CF and IGT may have an overall worse clinical status as indicated by BMI and FEV1. Data Source An exhaustive literature search was completed between July 2017 and September 2017 using PubMed, CINAHL, Web of Science, Dissertations & Theses, PsycINFO, and Open Grey. Studies were limited to human subjects with CF. There were no restrictions on publication date, study design or language. Study Selection Included studies examined BMI and FEV1 as outcome measures in individuals with CF and IGT compared to those with NGT. After screening for inclusion criteria, 12 observational studies met the specified conditions. Results Two studies showed a significantly worse BMI and FEV1 in subjects with CF and IGT compared to those with NGT. The remaining 10 studies found no significant associations with BMI and FEV1 in subjects with CF and IGT compared to NGT. Conclusion Although this review does not prove cause and effect, BMI and FEV1 are important outcome measures in patients with CF. Considering the inconclusive findings, practitioners should individualize care for this patient population. Additional research should focus on clinical status and interventions/treatment for individuals with CF and IGT.

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“…The insulin abnormalities in CF mean that glucose levels can be high during an OGTT but 'normal' at 120 min [9,24]. The insulin abnormalities in CF mean that glucose levels can be high during an OGTT but 'normal' at 120 min [9,24].…”

Section: Screening For Cystic Fibrosis-related Diabetesmentioning

confidence: 99%

“…The effect of glucose abnormalities on clinical status extends to prediabetes and situations where the diagnostic criteria for diabetes are not met. Clinical status is worse in those with impaired glucose tolerance after an OGTT, compared with those with normal glucose tolerance [23,24]. There are a few studies in CF demonstrating an association between clinical status and markers of lung function and relatively minor changes in glucose levels in those who do not meet the criteria for diabetes [25,26].…”

Section: Effect Of Subtle Glucose Changes On Clinical Statusmentioning

confidence: 99%

Unique challenges of cystic fibrosis‐related diabetes

Bridges

Rowe²,

Holt

2018

Diabet. Med.

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Individuals with cystic fibrosis and pancreatic insufficiency have a gradual decline in insulin secretion over time, which results in an increase in the prevalence of diabetes with age; up to 50% of adults with cystic fibrosis aged over 35 years have diabetes. Cystic fibrosis-related diabetes differs from Type 1 and Type 2 diabetes in several ways; there is a pattern of insulin deficiency with reduced and delayed insulin response to carbohydrates but a sparing of basal insulin that results in glucose abnormalities, which are frequently characterized by normal fasting glucose and postprandial hyperglycaemia. Insulin deficiency and hyperglycaemia, even at levels which do not reach the threshold for a diagnosis of diabetes, have an adverse impact on lung function and clinical status in people with cystic fibrosis. Although the risk of microvascular complications occurs as in other forms of diabetes, the main reason for treatment is to prevent deterioration in lung function and weight loss; treatment may therefore be required at an earlier stage than for other types of diabetes. Treatment is usually with insulin, but management needs to take into account all the other medical issues that arise in cystic fibrosis.

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The 1-h oral glucose tolerance test glucose and insulin values are associated with markers of clinical deterioration in cystic fibrosis

Abstract: Both insulin and glucose values at 60-min OGTT are associated with indicators of clinical degradation in adult patients with CF. Future prospective analyses are essential in establishing the clinical utility of these indicators.

Cited by 30 publications

References 32 publications

Reduced β-Cell Secretory Capacity in Pancreatic-Insufficient, but Not Pancreatic-Sufficient, Cystic Fibrosis Despite Normal Glucose Tolerance

Reduced β-Cell Secretory Capacity in Pancreatic-Insufficient, but Not Pancreatic-Sufficient, Cystic Fibrosis Despite Normal Glucose Tolerance

Impaired glucose tolerance, body mass index and respiratory function in patients with cystic fibrosis: A systematic review

Unique challenges of cystic fibrosis‐related diabetes

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