Abstract
Objectives
The diagnosis of cystic fibrosis related diabetes (CFRD) is not often easy as glucose homeostasis may be influenced by various disease-related conditions such as enteral continuous drip feeding, frequent acute illness, use of systemic corticosteroids and other concomitant medications. Other forms of diabetes should be considered in the diagnostic work-up, particularly in the first decade of life.
Case presentation
We hereby present the case of a cystic fibrosis 6-year-old female child diagnosed with glucokinase-maturity onset of diabetes of the young (GCK-MODY). The choice of treatment plan was doubtful since GCK-MODY does not usually require insulin treatment, but hyperglycemia could pose a threat to the respiratory tract. After intensive glucose monitoring, we decided to defer pharmacological treatment based on acceptable daily glycemic control. To date, no worsening in her respiratory function has been revealed.
Conclusions
Recognition of non-CFRD forms of diabetes is fundamental to plan the most suitable treatment and follow-up.
Research funding: This paper was not funded.
Author contributions: SP collected the data and drafted and wrote the paper; FL, CL and SC had in charge the patient; GBP and GS reviewed the paper. The paper has been read and approved by all the authors and each author considers that the paper represents their honest work.
Competing interests: The authors have no conflicts of interest to declare.
Informed consent: Informed consent was obtained from the patient’s parents included in this paper.
Ethical approval: The research has complied with all the relevant national regulations and institutional policies, and was conducted in accordance with the tenets of the Helsinki Declaration.
References
1. Banavath, LN, Kumar, R, Dayal, D, Yadav, J, Sachdeva, N, Mathew, JL, et al. Glucose intolerance in children with cystic fibrosis: a developing country’s perspective. J Pediatr Endocrinol Metab 2018;31:1139–46. https://doi.org/10.1515/jpem-2018-0222.Search in Google Scholar PubMed
2. Moran, A, Pillay, K, Becker, D, Granados, A, Hameed, S, Acerini, CL. ISPAD Clinical Practice Consensus Guidelines 2018: management of cystic fibrosis-related diabetes in children and adolescents. Pediatr Diabetes 2018;19 (27 Suppl):64–74. https://doi.org/10.1111/pedi.12732.Search in Google Scholar PubMed
3. Delvecchio, M, Mozzillo, E, Salzano, G, Iafusco, D, Frontino, G, Patera, PI, et al. Monogenic diabetes accounts for 6.3% of cases referred to 15 Italian pediatric diabetes centers during 2007–2012. J Clin Endocrinol Metab 2017;102:1826–34. https://doi.org/10.1210/jc.2016-2490.Search in Google Scholar PubMed
4. Frost, F, Dyce, P, Ochota, A, Pandya, S, Clarke, T, Walshaw, MJ, et al. Cystic fibrosis-related diabetes: optimizing care with a multidisciplinary approach. Diabetes Metab Syndrome Obes Targets Ther 2019;12:545–52. https://doi.org/10.2147/dmso.s180597.Search in Google Scholar PubMed PubMed Central
5. Kayani, K, Mohammed, R, Mohiaddin, H. Cystic fibrosis-related diabetes. Front Endocrinol (Lausanne) 2018;9:20. https://doi.org/10.3389/fendo.2018.00020.Search in Google Scholar PubMed PubMed Central
6. Moran, A, Brunzell, C, Cohen, RC, Katz, M, Marshall, BC, Onady, G, et al. 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. https://doi.org/10.2337/dc10-1768.Search in Google Scholar PubMed PubMed Central
7. Bellin, MD, Laguna, T, Leschyshyn, J, Regelmann, W, Dunitz, J, Billings, J. Insulin secretion improves in cystic fibrosis following ivacaftor correction of CFTR: a small pilot study. Pediatr Diabetes 2013;14:417–21. https://doi.org/10.1111/pedi.12026.Search in Google Scholar PubMed PubMed Central
8. Li, A, Vigers, T, Pyle, L, Zemanick, E, Nadeau, K, Sagel, SD, et al. Continuous glucose monitoring in youth with cystic fibrosis treated with lumacaftor-ivacaftor. J Cyst Fibros 2019;18:144–9. https://doi.org/10.1016/j.jcf.2018.07.010.Search in Google Scholar PubMed PubMed Central
9. Ballmann, M, Hubert, D, Assael, BM, Staab, D, Hebestreit, A, Naehrlich, L. Repaglinide versus insulin for newly diagnosed diabetes in patients with cystic fibrosis: a multicentre, open-label, randomised trial. Lancet Diabetes Endocrinol 2018;6:114–21. https://doi.org/10.1016/s2213-8587(17)30400-x.Search in Google Scholar
10. Gan, HW, Bhatt, JM, Denvir, L, Randell, T, Sachdev, P. Monogenic diabetes mellitus in cystic fibrosis. Arch Dis Child 2019;104:887–9. https://doi.org/10.1136/archdischild-2018-316141.Search in Google Scholar PubMed
11. Stride, A, Shields, B, Gill-Carey, O, Chakera, AJ, Colclough, K, Ellard, S, et al. Cross-sectional and longitudinal studies suggest pharmacological treatment used in patients with glucokinase mutations does not alter glycaemia. Diabetologia 2014;57:54–6. https://doi.org/10.1007/s00125-013-3075-x.Search in Google Scholar PubMed PubMed Central
12. Fattorusso, V, Casale, A, Raia, V, Mozzillo, E, Franzese, A. Long-term follow-up in a girl with cystic fibrosis and diabetes since the first year of life. Diabetes Ther 2017;8:1187–90. https://doi.org/10.1007/s13300-017-0289-9.Search in Google Scholar PubMed PubMed Central
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Research Articles
- Analysis of the alpha galactosidase gene: mutation profile and description of two novel mutations with extensive literature review in Turkish population
- Cascade screening and treatment of children with familial hypercholesterolemia in Turkey
- Risk of adrenal insufficiency following intra-articular or periarticular corticosteroid injections among children with chronic arthritis
- Vitamin D status is related to severity at onset of diabetes and worse glycemic control
- Reassessing vitamin D supplementation in preterm infants: a prospective study and review of the literature
- Mutations in PMM2 gene in four unrelated Spanish families with polycystic kidney disease and hyperinsulinemic hypoglycemia
- Liraglutide pharmacokinetics and exposure-response in pediatric patients with type 2 diabetes
- Identification of nucleotide polymorphism within the NeuroD1 candidate gene and its association with type 1 diabetes susceptibility in Iranian people by polymerase chain reaction-restriction fragment length polymorphism
- Prevalence of autoantibodies in type 1 diabetes mellitus pediatrics in Mazandaran, North of Iran
- Clinical features of the diabetes eating problem survey–revised Turkish version in children and adolescent with type 1 diabetes
- Ambulatory blood pressure profile in office normotensive obese children: prevalence of masked hypertension and impact of parental hypertension
- Glycogen storage disease type VI can progress to cirrhosis: ten Chinese patients with GSD VI and a literature review
- Short Communication
- Screening for imprinting disorders in 58 patients with clinically diagnosed idiopathic short stature
- Case Reports
- ROHHAD syndrome – A still unrecognized cause of childhood obesity: report of three cases
- Carbonic anhydrase VA deficiency: a very rare case of hyperammonemic encephalopathy
- Idiopathic infantile hypercalcemia: mutations in SLC34A1 and CYP24A1 in two siblings and fathers
- GCK-MODY in a child with cystic fibrosis: the doubt of the treatment plan
Articles in the same Issue
- Frontmatter
- Research Articles
- Analysis of the alpha galactosidase gene: mutation profile and description of two novel mutations with extensive literature review in Turkish population
- Cascade screening and treatment of children with familial hypercholesterolemia in Turkey
- Risk of adrenal insufficiency following intra-articular or periarticular corticosteroid injections among children with chronic arthritis
- Vitamin D status is related to severity at onset of diabetes and worse glycemic control
- Reassessing vitamin D supplementation in preterm infants: a prospective study and review of the literature
- Mutations in PMM2 gene in four unrelated Spanish families with polycystic kidney disease and hyperinsulinemic hypoglycemia
- Liraglutide pharmacokinetics and exposure-response in pediatric patients with type 2 diabetes
- Identification of nucleotide polymorphism within the NeuroD1 candidate gene and its association with type 1 diabetes susceptibility in Iranian people by polymerase chain reaction-restriction fragment length polymorphism
- Prevalence of autoantibodies in type 1 diabetes mellitus pediatrics in Mazandaran, North of Iran
- Clinical features of the diabetes eating problem survey–revised Turkish version in children and adolescent with type 1 diabetes
- Ambulatory blood pressure profile in office normotensive obese children: prevalence of masked hypertension and impact of parental hypertension
- Glycogen storage disease type VI can progress to cirrhosis: ten Chinese patients with GSD VI and a literature review
- Short Communication
- Screening for imprinting disorders in 58 patients with clinically diagnosed idiopathic short stature
- Case Reports
- ROHHAD syndrome – A still unrecognized cause of childhood obesity: report of three cases
- Carbonic anhydrase VA deficiency: a very rare case of hyperammonemic encephalopathy
- Idiopathic infantile hypercalcemia: mutations in SLC34A1 and CYP24A1 in two siblings and fathers
- GCK-MODY in a child with cystic fibrosis: the doubt of the treatment plan