Validation of Continuous Glucose Monitoring in Children and Adolescents With Cystic Fibrosis

O’Riordan, Stephen; Hindmarsh, Peter C.; Hill, Nathan R.; Matthews, David R.; George, Sherly; Greally, Peter; Canny, Gerard J.; Slattery, Dubhfeasa; Murphy, Nuala; Roche, Edna; Costigan, Colm; Hoey, Hilary

doi:10.2337/dc08-1925

Cited by 94 publications

(78 citation statements)

References 11 publications

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“…It is worth noting that CGMS has been recently validated in CF paediatric patients, being reliable, reproducible and repeatable (14). In accordance with this, in the present study, CGMS did not over-estimate glucose peaks: in the control group glucose excursions above 200 mg/dl were not registered.…”

Section: Discussionsupporting

confidence: 78%

“…There is now evidence that the OGTT method, evaluating fasting and 2-h postload glucose, may miss episodes of hyperglycaemia. It has been demonstrated recently that the continuous glucose monitoring system (CGMS) is a useful and valid tool in defining glucose metabolism in children and adults affected by CF with early glucose derangements (10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Abnormal glucose tolerance in children with cystic fibrosis: the predictive role of continuous glucose monitoring system

Schiaffini

Baratto

Russo

et al. 2010

European Journal of Endocrinology

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A long pre-diabetic phase of abnormal glucose tolerance is described in subjects with cystic fibrosis (CF) since childhood. Objective: The aims of the study were to compare oral glucose tolerance test (OGTT) and continuous glucose monitoring system (CGMS) in the diagnosis of altered glucose metabolism, and to longitudinally evaluate the role of CGMS in predicting glucose metabolism deterioration in children with CF. Methods: Seventeen children with CF and 14 controls were enrolled (mean age 13.3G3.0 years). All subjects underwent OGTT and CGMS registration. On the basis of OGTT, children were classified as normal glucose tolerance, impaired glucose tolerance (IGT), IGT plus at least one glucose value above 200 mg/dl at intermediate OGTT points (IGTC200) and CF-related diabetes (CFRD). HbA1c, glucose area under the curve, insulin sensitivity, and insulinogenic and disposition indexes were also considered. Subjects with CF underwent another OGTT after 2.5 years. Results: Baseline OGTT revealed 3/17 (7.6%) children with CF with at least one glucose value above 200 mg/dl (1 CFRD and 2 IGTC200), while CGMS revealed 6/17 (35.3%) children with glucose excursions above 200 mg/dl (PZ0.010). None of the controls showed glucose over 200 mg/dl either at OGTT or at CGMS. At the 2.5-year follow-up OGTT, all the six subjects who had diabetic glucose excursion (i.e. O200 mg/dl) at baseline CGMS presented IGTC200 or CFRD. In logistic regression analysis, CGMS diabetic excursion was the strongest predictor of IGTC200 and CFRD (P!0.001). Conclusions: CGMS could be a useful tool to predict glucose metabolism derangements in children affected by CF.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Abnormal glucose tolerance in children with cystic fibrosis: the predictive role of continuous glucose monitoring system

Schiaffini

Baratto

Russo

et al. 2010

European Journal of Endocrinology

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“…Ambulatory glucose profiles have been described for subjects with normal glucose tolerance, demonstrating changes in glucose over time, 27 and CGM has been used to demonstrate abnormal glucose profiles in insulinoma, cystic fibrosis, and bariatric surgery, among others. [28][29][30] Here, we describe normative reference ranges for all of the described methods of variability assessment in subjects without diabetes from varying ethnic origins.…”

mentioning

confidence: 99%

Normal Reference Range for Mean Tissue Glucose and Glycemic Variability Derived from Continuous Glucose Monitoring for Subjects Without Diabetes in Different Ethnic Groups

Hill

Oliver

Choudhary

et al. 2011

Diabetes Technology & Therapeutics

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312

258

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Background: Glycemic variability has been proposed as a contributing factor in the development of diabetes complications. Multiple measures exist to calculate the magnitude of glycemic variability, but normative ranges for subjects without diabetes have not been described. For treatment targets and clinical research we present normative ranges for published measures of glycemic variability. Methods: Seventy-eight subjects without diabetes having a fasting plasma glucose of < 120 mg/dL (6.7 mmol/L) underwent up to 72 h of continuous glucose monitoring (CGM) with a Medtronic Minimed (Northridge, CA) CGMS Ò Gold device. Glycemic variability was calculated using EasyGV ª software (available free for noncommercial use at www.easygv.co.uk), a custom program that calculates the SD, M-value, mean amplitude of glycemic excursions (MAGE), average daily risk ratio (ADRR), Lability Index (LI), J-Index, Low Blood Glucose Index (LBGI), High Blood Glucose Index (HBGI), continuous overlapping net glycemic action (CONGA), mean of daily differences (MODD), Glycemic Risk Assessment in Diabetes Equation (GRADE), and mean absolute glucose (MAG). Results: Eight CGM traces were excluded because there were inadequate data. From the remaining 70 traces, normative reference ranges (mean -2 SD) for glycemic variability were calculated: SD, 0-3.0; CONGA, 3.6-5.5; LI, LBGI, HBGI, GRADE, MODD, ADDR, and MAG,. Conclusions: We present normative ranges for measures of glycemic variability in adult subjects without diabetes for use in clinical care and academic research.

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“…80 Glucose excursions .200 mg/dL on CGM successfully predicted the development of IGT or CFRD as diagnosed by OGTT in a 2.5-year period. 81 Hameed 82 confirmed the validity and reproducibility of CGM in over 100 children with CF.…”

Section: Continuous Glucose Monitoring (Cgm)mentioning

confidence: 80%

Cystic fibrosis-related diabetes: links, challenges, and future directions

Sheikh¹,

Kelly²

2015

RRED

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Cystic fibrosis-related diabetes (CFRD) is a common comorbidity in cystic fibrosis (CF) and portends worse clinical outcomes including lower lung function and nutritional status, and decreased survival. CFRD is distinct from other forms of diabetes, but relative insulin deficiency is a predominant feature. The catabolic effects of insulin deficiency coupled with the pro-inflammatory effects of hyperglycemia likely affect clinical outcomes. Posited mechanisms of CFRD development include collateral damage from pancreatic exocrine destruction, inherent β-cell defect, CFTR dysfunction, and incretin deficiency or unresponsiveness. Even though CF clinical care teams are increasingly aware of its implications, CFRD screening and management remain a challenge. Promising clinical and basic research in the fields of diabetes and CF and the advent of novel therapeutics targeting the protein defect in CF have potential to change CFRD care. This review presents newer data on insulin defects and glucose derangements and highlights continuing challenges and unanswered questions.

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Validation of Continuous Glucose Monitoring in Children and Adolescents With Cystic Fibrosis

Cited by 94 publications

References 11 publications

Abnormal glucose tolerance in children with cystic fibrosis: the predictive role of continuous glucose monitoring system

Abnormal glucose tolerance in children with cystic fibrosis: the predictive role of continuous glucose monitoring system

Normal Reference Range for Mean Tissue Glucose and Glycemic Variability Derived from Continuous Glucose Monitoring for Subjects Without Diabetes in Different Ethnic Groups

Cystic fibrosis-related diabetes: links, challenges, and future directions

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