Natural History of Glucose Intolerance in Patients with Cystic Fibrosis: Ten-Year Prospective Observation Program
| Autor: | Anca Sterescu, Annie Dupuis, A. K. Hanna, Paul B. Pencharz, David Wilson, Bronwen Rhodes, Elizabeth Tullis, Reuben Jackson |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Time Factors Cystic Fibrosis endocrine system diseases Cystic fibrosis-related diabetes Gastroenterology Cystic fibrosis Body Mass Index Impaired glucose tolerance Insulin resistance Diabetes mellitus Internal medicine Glucose Intolerance medicine Humans Glucose homeostasis Prospective Studies Prospective cohort study Ontario Glucose tolerance test medicine.diagnostic_test business.industry Incidence nutritional and metabolic diseases Forced Expiratory Flow Rates Glucose Tolerance Test Prognosis medicine.disease Endocrinology Pediatrics Perinatology and Child Health Disease Progression Female business Follow-Up Studies |
| Zdroj: | The Journal of Pediatrics. 156:613-617 |
| ISSN: | 0022-3476 |
| DOI: | 10.1016/j.jpeds.2009.10.019 |
| Popis: | Objective To determine prospectively the long-term natural history of glucose homeostasis in adult patients with cystic fibrosis (CF). Study design Between 1996 and 2005, a total of 971 modified oral glucose tolerance tests (OGTTs) were performed in 329 patients with CF without recognized CF-related diabetes (CFRD). Patients were classified as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), CFRD without fasting hyperglycemia (FH), or CFRD with FH. Data were collected at baseline from the Toronto Cystic Fibrosis database. Results On first OGTT, 63% of the 257 patients with pancreatic insufficiency (PI) had NGT, 23% had IGT, 11% had CFRD without FH, and 3% had CFRD with FH. Burkholderia cepacia complex colonization was correlated with worsening glucose tolerance category. There was a weak inverse relationship among weight, body mass index, forced expiratory volume in 1 minute, and 2-hour plasma glucose obtained during OGTT. Of the 168 PI patients who had a second OGTT, 17% improved their category of glucose tolerance, 70% remained unchanged, and 13% worsened. A similar trend was seen during the progression between any one test to a subsequent test. Conclusions Annual screening of glucose tolerance in patients with CF reveals highly variable results over time. Fluctuating levels of insulin resistance, probably with variable degrees of ongoing inflammation, affect the results and hinder prediction of future development of CFRD. Home glucose monitoring following abnormal OGTT results was essential in establishing the diagnosis of CFRD. |
| Databáze: | OpenAIRE |
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