期刊
JORNAL BRASILEIRO DE PNEUMOLOGIA
卷 48, 期 2, 页码 -出版社
SOC BRASILEIRA PNEUMOLOGIA TISIOLOGIA
DOI: 10.36416/1806-3756/e20210307
关键词
Cystic fibrosis; Glucose intolerance; Glucose tolerance test; Diabetes mellitus
Continuous glucose monitoring is effective in detecting glucose abnormalities in pediatric patients with cystic fibrosis. However, it is not a reliable predictor for the onset of cystic fibrosis-related diabetes. Different diagnostic criteria may be required for patients with cystic fibrosis.
Objective: To determine whether abnormal continuous glucose monitoring (CGM) readings (hypoglycemia/ hyperglycemia) can predict the onset of cystic fibrosis-related diabetes (CFRD) and/or clinical impairment (decline in BMI and/or FEV1) in pediatric patients with cystic fibrosis ( CF). Methods: This was a longitudinal prospective cohort study involving CF patients without diabetes at baseline. The mean follow-up period was 3.1 years. The patients underwent 3-day CGM, performed oral glucose tolerance test (OGTT), and had FEV1 and BMI determined at baseline. OGTT, FEV1, and BMI were reassessed at the end of the follow-up period. Results: Thirty-nine CF patients (10-19 years of age) had valid CGM readings at baseline, and 34 completed the follow-up period (mean = 3.1 +/- 0.5 years). None of the study variables predicted progression to CFRD or were associated with hypoglycemic events. CGM could detect glucose abnormalities not revealed by OGTT. Patients with glucose levels = 140 mg/dL, as compared with those with lower levels, on CGM showed lower BMI values and z-scores at baseline-17.30 +/- 3.91 kg/m(2) vs. 19.42 +/- 2.07 kg/m(2); p = 0.043; and -1.55 +/- 1.68 vs. -0.17 +/- 0.88; p = 0.02, respectively-and at the end of follow-up-17.88 +/- 3.63 kg/m2 vs. 19.95 +/- 2.56 kg/m(2); p = 0.039; and -1.65 +/- 1.55 vs. -0.42 +/- 1.08; p = 0.039. When comparing patients with and without CFRD, the former were found to have worse FEV1 (in % of predicted)-22.67 +/- 5.03 vs. 59.58 +/- 28.92; p = 0.041-and a greater decline in FEV1 (-36.00 +/- 23.52 vs. -8.13 +/- 17.18; p = 0.041) at the end of follow-up. Conclusions: CGM was able to identify glucose abnormalities not detected by OGTT that were related to early-stage decreases in BMI. CGM was ineffective in predicting the onset of diabetes in this CF population. Different diagnostic criteria for diabetes may be required for individuals with CF.
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