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Hypoglycemia is common in children with cystic fibrosis and seen predominantly in females
Author(s) -
Haliloglu Belma,
Gokdemir Yasemin,
Atay Zeynep,
Abali Saygin,
Guran Tulay,
Karakoc Fazilet,
Ersu Refika,
Karadag Bulent,
Turan Serap,
Bereket Abdullah
Publication year - 2017
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12470
Subject(s) - medicine , hypoglycemia , cystic fibrosis , subgroup analysis , body mass index , endocrinology , diabetes mellitus , cystic fibrosis related diabetes , insulin , gastroenterology , hemoglobin , insulin resistance , impaired glucose tolerance , confidence interval
Objective To determine the prevalence of hypoglycemia in children and adolescents with cystic fibrosis ( CF ) in 2‐hour oral glucose tolerance test ( OGTT ) and continuous glucose monitoring ( CGM ) under free‐living conditions. Research Design and Methods Height, weight, body mass index ( BMI ), hemoglobin A1c ( HbA1c ), and Forced expiratory volume (FEV1%) were measured in children with CF (aged 5‐18 years). Following OGTT , CGM was installed for 3 days. The total hypoglycemic and hyperglycemic time (%) during 3 days was measured. Subjects were categorized according to hypoglycemic time <3% (hypo −) and ≥3% (hypo +). Each category was further divided according to hyperglycemic time <3% (hyper −) or ≥3% (hyper +). Results OGTT and CGM were sequentially performed in 45 CF patients. The frequency of hypoglycemia in OGTT and hypoglycemic time ≧3% of CGM were 13.3% and 27.5%, respectively. After 5 cystic fibrosis‐related diabetes ( CFRD ) subjects were excluded, the number of subjects in each subgroup was 17 (hypo−/hyper−), 12 (hypo−/hyper+), 6 (hypo+/hyper−), and 5 (hypo+/hyper+). Significantly higher insulin at 120 minutes was observed in OGTT in (hypo+/hyper−), as compared with subgroup (hypo−/hyper−) ( P = .018). Total insulin levels were also significantly higher in (hypo+/hyper−), than (hypo−/hyper−), but were similar to those in the healthy control group ( P = .049 and P = .076, respectively). There was a female predominance in hypoglycemic subjects both in OGTT and subgroup (hypo+/hyper−) in the CGM group ( P = .033 and P = .033, respectively). FEV1 was significantly lower in hypo + group as a whole, and (hypo+/hyper+) subgroup than in (hypo‐/hyper−), ( P = .044 and P = .042, respectively); the difference was independent of body mass index‐standard deviation score ( BMI‐SDS ) ( P = .15 and P = .12, respectively). Conclusion The frequency of hypoglycemia in children with CF was higher in CGM than that in OGTT . Insulin secretion was delayed and total insulin levels increased in the hypoglycemic patients. Glucose instability/hypoglycemia is associated with poorer lung function in patients with CF , independent of nutritional status.