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Trajectories of oral glucose tolerance testing in cystic fibrosis
Author(s) -
Patel Monal,
McCracken Courtney,
Daley Tanicia,
Stecenko Arlene,
Linnemann Rachel
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25207
Subject(s) - medicine , cystic fibrosis , cystic fibrosis related diabetes , diabetes mellitus , glucose homeostasis , type 2 diabetes , glucose tolerance test , cohort , gastroenterology , impaired glucose tolerance , retrospective cohort study , cohort study , pulmonary function testing , endocrinology , insulin resistance
Annual oral glucose tolerance testing (OGTT) is the recommended screening modality for cystic fibrosis‐related diabetes (CFRD) in patients with cystic fibrosis (CF). This study aimed to determine if there were patterns of progression of worsening glucose homeostasis in pediatric CF patients and to explore any relationship to lung function. Methods We conducted a retrospective cohort study of CF patients, ages 10–18 years, without CFRD and with ≥3 OGTT from 2013 to 2016. Latent class mixture models were used to determine unique trajectories of 2‐h OGTT glucose values (2hrGlu) over time. Multivariable linear models were used to adjust for clinical covariates. Results For 63 subjects, three unique 2hrGlu trajectories were identified: high (impaired glucose tolerance) to higher ( n = 8), low (normal glucose tolerance [NGT]) and increasing ( n = 47), and low (NGT) and flat ( n = 8). There was high variability of 2hrGlu, but most patients belonged to a trajectory that increased over time. After controlling for age, pancreatic insufficiency, modulator use, and mutation type, there was a significant difference in the study baseline forced expiratory volume in 1 s percent predicted (ppFEV 1 ) in the high to higher group compared to the low and increasing and low and flat groups ( p < .005). Discussion Among pediatric CF patients without diabetes, three 2hrGlu trajectories were identified with 87% of patients exhibiting a trajectory where glucose homeostasis worsened over time. Starting ppFEV 1 was lower in those with a high to higher trajectory, supporting that lower lung function is present early in the development of CFRD.