Diabetes outbreak during COVID19 lock-down in a prediabetic patient with cystic fibrosis long treated with glargine

BackgroundCystic Fibrosis Related Diabetes (CFRD) is a frequent comorbidity of patients with Cystic Fibrosis (CF). A worsening of clinical conditions appears before CFRD. It has been demonstrated a decline in pulmonary function and nutritional status also in patients with prediabetes. Few trials show that insulin may be beneficial in prediabetic CF patients, to date guidelines do not recommend for this condition.Case presentationWe report a case of a patient treated with insulin glargine at 13years, due to glycemic intolerance, and with Lumacaftor/Ivacaftor at 15years. A reduction of pulmonary exacerbations was observed after glargine therapy, also confirmed after the starting of Lumacaftor/ Ivacaftor in this patient. Pulmonary function improved only after the first year of glargine therapy, then a deterioration appeared due to the natural history of CF lung damage. During the COVID-19 lockdown, poor adherence to care contributed to diabetes mellitus onset needing high insulin requirements. After two weeks the patient returned to prediabetic condition and his previous dose of glargine.Conclusionsour case highlights firstly that insulin glargine has contributed to preserve him from further clinical worsening due to prediabetes in the years before pandemic, secondly the negative impact of COVID-19 lockdown on the clinical course of a chronic disease as CF.

Automated summary

This case firstly highlights the contribution of insulin glargine in preserving the patient from further clinical deterioration due to prediabetes in the years before the pandemic, and secondly underscores the negative impact of the COVID-19 lockdown on the clinical course of a chronic disease like CF.