Glucose Tolerance in Patients with Cystic Fibrosis – Results from the German Cystic Fibrosis Registry

Author:

Prinz Nicole12ORCID,Wosniok Julia3,Staab Doris4,Ballmann Manfred5,Dopfer Christian6,Regenfuß Nicole3,Rosenecker Josef7,Schramm Dirk8,W. Reinhard Holl12,Nährlich Lutz9

Affiliation:

1. Institute of Epidemiology and Medical Biometry (ZIBMT), Ulm University, Ulm

2. German Center for Diabetes Research (DZD), Munich-Neuherberg

3. Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Centre Mainz, Mainz

4. Paed. Pneumology, Univ. Childrenʼs Hospital Charité, Berlin

5. Pediatric Clinic, University Medicine Rostock, Rostock

6. Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover

7. Department of Pediatrics, Dr. von Hauner Childrenʼs Hospital, Ludwig Maximilian University, Munich

8. Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Childrenʼs Hospital, Medical Faculty, Heinrich Heine University, Düsseldorf

9. Department of Pediatrics, Justus-Liebig-University giessen, Giessen

Abstract

Abstract Background Oral glucose tolerance (OGT) deteriorates progressively in cystic fibrosis (CF). Clinical registries provide a unique basis to study real-world data. Patients & methods OGT tests (OGTTs) documented in the German CF-registry in 2016 were classified according WHO, modified by ADA: normal glucose tolerance (NGT), indeterminate glycaemia (INDET), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT, diabetes mellitus (DM). To study the association with lung function, multivariable regression adjusted for age, sex, and CFTR mutation was performed. Results Overall, OGTT screening was done in 35% of CF patients ≧10 years. Of the 996 patients (46.4% females; median age (IQR): 19 (14–27) years) with evaluable OGTTs, 56.2% had either NGT or INDET, whereas 34% had a pre-diabetic OGTT (IFG; IGT; IFG+IGT) and 9.8% a diabetic OGTT. 7 patients had glucose tolerance abnormalities <10 years. DM was more common in females or patients with F508del homozygote mutation, whereas IFG was more frequent in males (all p<0.05). Nearly 75% of patients after transplantation and about half with enteral/parental nutrition and/or steroid use had either a pre-diabetic or diabetic glucose tolerance. In the adjusted model, age (p<0.001) and OGTT category (p=0.013) had both a significant impact on %FEV1. Conclusion Our data of the German CF-registry highlights incidence of glucose tolerance abnormalities in second decade of life in CF patients. However, it also underlines the need for improvement of the documentation and/or performance of OGTT screening in real-world CF care.

Publisher

Georg Thieme Verlag KG

Subject

Pediatrics, Perinatology, and Child Health

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