Sensitivity and specificity of different methods for cystic fibrosis-related diabetes screening: is the oral glucose tolerance test still the standard?

Catherine Mainguy; Gabriel Bellon; Véronique Delaup; Tiphanie Ginoux; Behrouz Kassai-Koupai; Stéphane Mazur; Muriel Rabilloud; Laurent Remontet; Philippe Reix

doi:10.1515/jpem-2016-0184

Article

Sensitivity and specificity of different methods for cystic fibrosis-related diabetes screening: is the oral glucose tolerance test still the standard?

Catherine Mainguy , Gabriel Bellon , Véronique Delaup , Tiphanie Ginoux , Behrouz Kassai-Koupai , Stéphane Mazur , Muriel Rabilloud , Laurent Remontet and Philippe Reix

Published/Copyright: December 15, 2016

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 30 Issue 1

Abstract

Background:

Cystic fibrosis-related diabetes (CFRD) is a late cystic fibrosis (CF)-associated comorbidity whose prevalence is increasing sharply lifelong. Guidelines for glucose metabolism (GM) monitoring rely on the oral glucose tolerance test (OGTT). However, this test is neither sensitive nor specific. The aim of this study was to compare sensitivity and specificity of different methods for GM monitoring in children and adolescents with CF.

Methods:

Continuous glucose monitoring system (CGMS), used as the reference method, was compared with the OGTT, intravenous glucose tolerance test (IGTT), homeostasis model assessment index of insulin resistance (HOMA-IR), homeostasis model assessment index of β-cell function (HOMA-%B) and glycated haemoglobin A_1C. Patients were classified into three groups according to CGMS: normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes mellitus (DM).

Results:

Twenty-nine patients (median age: 13.1 years) were recruited. According to CGMS, 11 had DM, 12 IGT and six NGT, whereas OGTT identified three patients with DM and five with IGT. While 13 of 27 had insulin deficiency according to IGTT, there was 19 of 28 according to HOMA-%B. According to HOMA-IR, 12 of 28 had insulin resistance. HOMA-%B was the most sensitive method for CFRD screening [sensitivity 91% (95% CI), specificity 47% (95% CI) and negative predictive value 89% (95% CI)].

Conclusions:

OGTT showed the weak capacity to diagnose DM in CF and should no longer be considered as the reference method for CFRD screening in patients with CF. In our study, HOMA-%B showed promising metrics for CFRD screening. Finally, CGMS revealed that pathological glucose excursions were frequent even early in life.

Keywords: continuous glucose monitoring system; cystic fibrosis-related diabetes; glucose metabolism; homeostasis model assessment index of β-cell function; homeostasis model assessment index of insulin resistance; intravenous glucose tolerance test; oral glucose tolerance test

Corresponding author: Catherine Mainguy, MD, Hospices civils de Lyon, Service de pneumologie pédiatrique, Centre de ressources et de compétences de la mucoviscidose, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69500 Bron, France, Phone: +33 4 72 12 94 37

Acknowledgments

The authors thank Prof. Isabelle Durieu for valuable comments on the manuscript. The authors are grateful to patients and parents who accepted to participate in this study. The authors have no conflict of interest related to this study to declare.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This research was supported by grants from the Vaincre La Mucoviscidose (VLM) Association and the Association Lyonnaise de Logistique Post hospitalière (ALLP).
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Article note:

This work was presented in part at the ECSF meeting in 2012 in Dublin.

Received: 2016-5-11

Accepted: 2016-11-11

Published Online: 2016-12-15

Published in Print: 2017-1-1

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https://doi.org/10.1515/jpem-2016-0184

Keywords for this article

continuous glucose monitoring system; cystic fibrosis-related diabetes; glucose metabolism; homeostasis model assessment index of β-cell function; homeostasis model assessment index of insulin resistance; intravenous glucose tolerance test; oral glucose tolerance test