Glucose intolerance in children with cystic fibrosis: a developing country’s perspective
-
Lakshmipathi Naik Banavath
,
Devi Dayal
Abstract
Background
Cystic fibrosis-related diabetes (CFRD) is a common comorbidity reported in patients with cystic fibrosis (CF). There is a dearth of data on glucose intolerance or CFRD in children with CF from developing countries. So, we planned to study the prevalence of abnormal glucose tolerance (AGT) in children with CF and its relation with the duration and severity of CF.
Methods
We performed an oral glucose tolerance test (OGTT) on children (2–18 years old) having CF for at least 6 months. Two-hour plasma glucose levels on OGTT were correlated with various disease-related factors.
Results
Out of the 25 children enrolled, there were 18 boys and seven girls. The mean age and duration of CF were 7.9±4.3 and 3.16±2.5 years, respectively. AGT was observed in 16 (64%) children with CF including three (12%) children with CFRD. Children with a duration of CF of 3 years had significantly higher prevalence (81.8%) of AGT when compared with duration ≤3 years (p-value<0.05). Twelve out of 17 (70.6%) children were colonized with Pseudomonas and 12 out of 15 (80%) children >6 years of age had AGT. There was a positive correlation of 2-h glucose value on OGTT with duration of CF and number of hospitalizations with acute pulmonary exacerbations.
Conclusions
The majority of children having CF for >3 years and/or age >6 years developed AGT. In our clinical setting, an annual screening with OGTT to detect AGT may be required at an early age and duration of CF.
Author contributions: RK conceptualized the study design. The study protocol was written and approved by all authors. LNB was involved in the recruitment and enrollment of study subjects and analyzed data. DD, RK, JY, JLM, MS and PCV were involved in the clinical care of the patients. The first draft of the manuscript was written by LNB and revised and edited by RK. NS was involved in doing lab assessments and critical review of the manuscript. All authors reviewed and approved the final manuscript.
Research funding: None declared.
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.
References
1. Salvatore D, Buzzetti R, Baldo E, Forneris MP, Lucidi V, et al. An overview of international literature from cystic fibrosis registries. Part 3. Disease incidence, genotype/phenotype correlation, microbiology, pregnancy, clinical complications, lung transplantation, and miscellanea. J Cyst Fibros 2011;10:71–85.10.1016/j.jcf.2010.12.005Search in Google Scholar PubMed
2. Kapoor V, Shastri SS, Kabra M, Kabra SK, Ramachandran V, et al. Carrier frequency of F508del mutation of cystic fibrosis in Indian population. J Cyst Fibros 2006;5:43–6.10.1016/j.jcf.2005.10.002Search in Google Scholar PubMed
3. Moran A, Dunitz J, Nathan B, Saeed A, Holme B, et al. Cystic fibrosis-related diabetes: current trends in prevalence, incidence, and mortality. Diabetes Care 2009;32:1626–31.10.2337/dc09-0586Search in Google Scholar PubMed PubMed Central
4. Moran A, Pillay K, Becker DJ, Acerini CL. International Society for Pediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines 2014. Management of cystic fibrosis-related diabetes in children and adolescents. Pediatr Diabetes 2014;Suppl 20:65–76.10.1111/pedi.12178Search in Google Scholar PubMed
5. Lombardi F, Raia V, Spagnuolo MI, Nugnes R, Valerio G, et al. Diabetes in an infant with cystic fibrosis. Pediatr Diabetes 2004;5:199–201.10.1111/j.1399-543X.2004.00069.xSearch in Google Scholar PubMed
6. Kabra SK, Kabra M, Connett GJ, Rolles CJ. Diagnosis of cystic fibrosis: Indian perspective. Indian J Pediatr 1999;66:923–8.10.1007/BF02723869Search in Google Scholar PubMed
7. Kabra SK, Kabra M, Lodha R, Shastri S. Cystic fibrosis in India. Pediatr Pulmonol 2007;42:1087–94.10.1002/ppul.20677Search in Google Scholar PubMed
8. Jain V, Kumar S, Vikram NK, Kalaivani M, Bhatt SP, et al. Glucose tolerance and insulin secretion and sensitivity characteristics in Indian children with cystic fibrosis: a pilot study. Indian J Med Res 2017;146:483–8.Search in Google Scholar
9. World Health Organization, International Diabetes Federation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation [Internet]; 2006 [cited 2018 Jan 16]. Available from: http://www.who.int/diabetes/publications/diagnosis_diabetes2006/en/.Search in Google Scholar
10. Moran A, Brunzell C, Cohen RC, Katz M, Marshall BC, et al. CFRD Guidelines Committee. Clinical care guidelines for cystic fibrosis-related diabetes: a position statement of the American Diabetes Association and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society. Diabetes Care 2010;33:2697–708.10.2337/dc10-1768Search in Google Scholar PubMed PubMed Central
11. Cersosimo E, Solis-Herrera C, Trautmann ME, Malloy J, Triplitt CL. Assessment of pancreatic β-cell function: review of methods and clinical applications. Curr Diabetes Rev 2014;10:2–42.10.2174/1573399810666140214093600Search in Google Scholar PubMed PubMed Central
12. Garagorri JM, Rodríguez G, Ros L, Sanchez A. Early detection of impaired glucose tolerance in patients with cystic fibrosis and predisposition factors. J Pediatr Endocrinol Metab 2011;14:53–60.10.1515/JPEM.2001.14.1.53Search in Google Scholar
13. Lanng S, Hansen A, Thorsteinsson B, Nerup J, Koch C. Glucose tolerance in patients with cystic fibrosis: five year prospective study. Br Med J 1995;311:655–9.10.1136/bmj.311.7006.655Search in Google Scholar PubMed PubMed Central
14. Elder DA, Wooldridge JL, Dolan LM, D’Alessio DA. Glucose tolerance, insulin secretion, and insulin sensitivity in children and adolescents with cystic fibrosis and no prior history of diabetes. J Pediatr 2007;151:653–8.10.1016/j.jpeds.2007.05.012Search in Google Scholar PubMed
15. Schiaffini R, Brufani C, Russo B, Fintini D, Migliaccio A, et al. AGT in children with cystic fibrosis: the predictive role of continuous glucose monitoring system. Eur J Endocrinol 2010;162:705–10.10.1530/EJE-09-1020Search in Google Scholar PubMed
16. Mozzillo E, Raia V, Fattorusso V, Falco M, Sepe A, et al. Glucose derangements in very young children with cystic fibrosis and pancreatic insufficiency. Diabetes Care 2012;35:e78.10.2337/dc12-0459Search in Google Scholar PubMed PubMed Central
17. Yi Y, Norris AW, Wang K, Sun X, Uc A, et al. AGT in infants and young children with cystic fibrosis. Am J Respir Crit Care Med 2016;194:974–80.10.1164/rccm.201512-2518OCSearch in Google Scholar PubMed PubMed Central
18. Ode KL, Frohnert B, Laguna T, Phillips J, Holme B, et al. Oral glucose tolerance testing in children with cystic fibrosis. Pediatr Diabetes 2010;11:487–92.10.1111/j.1399-5448.2009.00632.xSearch in Google Scholar PubMed PubMed Central
19. Sterescu AE, Rhodes B, Jackson R, Dupuis A, Hanna A, et al. Natural history of glucose intolerance in patients with cystic fibrosis: ten-year prospective observation program. J Pediatr 2010;156:613–7.10.1016/j.jpeds.2009.10.019Search in Google Scholar PubMed
20. Brodsky J, Dougherty S, Makani R, Rubenstein RC, Kelly A. Elevation of 1-hour plasma glucose during oral glucose tolerance testing is associated with worse pulmonary function in cystic fibrosis. Diabetes Care 2011;34:292–5.10.2337/dc10-1604Search in Google Scholar PubMed PubMed Central
21. Dobson L, Sheldon CD, Hattersley AT. Conventional measures underestimate glycaemia in CF patients. Diabet Med 2004;21:691–6.10.1111/j.1464-5491.2004.01219.xSearch in Google Scholar PubMed
22. Boudreau V, Coriati A, Desjardins K, Rabasa-Lhoret R. Glycated hemoglobin cannot yet be proposed as a screening tool for cystic fibrosis related diabetes. J Cyst Fibros 2016;15:258–60.10.1016/j.jcf.2016.02.005Search in Google Scholar PubMed
23. Moran A, Diem P, Klein DJ, Levitt MD, Robertson RP. Pancreatic endocrine function in cystic fibrosis. J Pediatr 1991;118: 715–23.10.1016/S0022-3476(05)80032-0Search in Google Scholar
24. Hammana I, Potvin S, Tardif A, Berthiaume Y, Coderre L, et al. Validation of insulin secretion indices in cystic fibrosis patients. J Cyst Fibros 2009;8:378–81.10.1016/j.jcf.2009.08.007Search in Google Scholar PubMed
©2018 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Original Articles
- The associations between mental health, health-related quality of life and insulin pump therapy among children and adolescents with type 1 diabetes
- Achieving target levels for vascular risk parameters in Polish school-age children with type 1 diabetes – a single center study
- Adipocyte aquaporin 7 (AQP7) expression in lean children and children with obesity. Possible involvement in molecular mechanisms of childhood obesity
- Use of complementary and alternative medicine in patients with inherited metabolic disease
- Are breast milk adipokines affected by maternal dietary factors?
- Comparison of serum 25-hydroxyvitamin D levels between radioimmunoassay and liquid chromatography-tandem mass spectrometry in infants and postpartum women
- Reference intervals for neonatal thyroid function tests in the first 7 days of life
- Treatment outcomes in pediatric differentiated thyroid carcinoma
- Seasonality of month of birth in children and adolescents with autoimmune thyroiditis: a continuing conundrum
- Follow-up in children with non-obese and non-autoimmune subclinical hypothyroidism
- Glucose intolerance in children with cystic fibrosis: a developing country’s perspective
- Letter to the Editor
- A patient with classical galactosemia is graduated with a university degree
- Case Reports
- Prepubertal gynaecomastia in a boy with Peutz-Jeghers syndrome: managing the aromatase overexpression
- Hypogammaglobulinemia and imaging features in a patient with infantile free sialic acid storage disease (ISSD) and a novel mutation in the SLC17A5 gene
- Xanthogranuloma of the sellar region accompanied by growth hormone deficiency: case report and literature review
- A case of Graves’ disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis
Articles in the same Issue
- Frontmatter
- Original Articles
- The associations between mental health, health-related quality of life and insulin pump therapy among children and adolescents with type 1 diabetes
- Achieving target levels for vascular risk parameters in Polish school-age children with type 1 diabetes – a single center study
- Adipocyte aquaporin 7 (AQP7) expression in lean children and children with obesity. Possible involvement in molecular mechanisms of childhood obesity
- Use of complementary and alternative medicine in patients with inherited metabolic disease
- Are breast milk adipokines affected by maternal dietary factors?
- Comparison of serum 25-hydroxyvitamin D levels between radioimmunoassay and liquid chromatography-tandem mass spectrometry in infants and postpartum women
- Reference intervals for neonatal thyroid function tests in the first 7 days of life
- Treatment outcomes in pediatric differentiated thyroid carcinoma
- Seasonality of month of birth in children and adolescents with autoimmune thyroiditis: a continuing conundrum
- Follow-up in children with non-obese and non-autoimmune subclinical hypothyroidism
- Glucose intolerance in children with cystic fibrosis: a developing country’s perspective
- Letter to the Editor
- A patient with classical galactosemia is graduated with a university degree
- Case Reports
- Prepubertal gynaecomastia in a boy with Peutz-Jeghers syndrome: managing the aromatase overexpression
- Hypogammaglobulinemia and imaging features in a patient with infantile free sialic acid storage disease (ISSD) and a novel mutation in the SLC17A5 gene
- Xanthogranuloma of the sellar region accompanied by growth hormone deficiency: case report and literature review
- A case of Graves’ disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis
