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. 2020 May;19(3):460-465.
doi: 10.1016/j.jcf.2019.12.016. Epub 2020 Jan 22.

Glycemic control and FEV1 recovery during pulmonary exacerbations in pediatric cystic fibrosis-related diabetes

William Okoniewski  1 , Kara S Hughan  2 , Gabriel A Weiner  3 , Daniel J Weiner  1 , Erick Forno  4
Affiliations

Glycemic control and FEV1 recovery during pulmonary exacerbations in pediatric cystic fibrosis-related diabetes

William Okoniewski et al. J Cyst Fibros. 2020 May.

Abstract

Rationale: Whether short-term glucose control in cystic fibrosis-related diabetes (CFRD) is associated with FEV1 recovery during acute pulmonary exacerbations is unclear.

Methods: Data from all patients with CFRD ages 6-21 years hospitalized in 2010-2016 for pulmonary exacerbations at our CF Center were analyzed, including CFRD status at each encounter, all FEV1 recorded during each exacerbation, and relevant clinical covariates. Glucose control was analyzed using meter blood glucose area under the curve (AUC) indices. The primary outcome was FEV1 recovery.

Results: Patients with CFRD who finished IV antibiotics at home were treated for longer than those fully treated in the hospital (22.2 vs. 13.8 days). In those who finished treatment at home, poor inpatient glycemic control was associated with lower lung function improvement: when comparing the 75th to the 25th percentile of each glycemic index (i.e., "poorer" vs. "better" glycemic control), FEV1 recovery at discharge was 20.1% lower for glucose AUC (95%CI -0.4%, -39.9%); 20.9% lower for 48-h AUC (95%CI -2.7%, -39.1%); and 28.2% lower for AUC/day (95%CI -7.1%, -49.3%). Similar results were found at the end of IV antibiotics and at clinic follow-up. Likewise, patients with poor glycemic control had a lower slope of inpatient FEV1 recovery. Analysis in patients with normal glucose tolerance was largely non-significant. No associations were found between hemoglobin A1c and FEV1 recovery.

Conclusions: In patients with CFRD who complete IV antibiotic treatment at home, poor inpatient glycemic control is associated with worse FEV1 recovery despite longer duration of treatment.

Keywords: Cystic fibrosis; Cystic fibrosis-related diabetes; Glycemic control; Lung function.

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Conflict of interest statement

Declaration of Competing Interest The authors have no competing interests to declare.

Figures

Figure 1 –
Figure 1 –. Example of MBG glycemic control patterns in patients with CFRD
Meter blood glucose (MBG) concentrations from two actual patients with CFRD, shown as examples of different patterns of glycemic control.
Figure 2 –
Figure 2 –. FEV1 trajectories for patients with normal glucose tolerance (NGT), well-controlled CFRD, and poorly-controlled CFRD
Poorly-controlled CFRD was defined as AUC/day in the highest quartile (quartile 4); well-controlled CFRD was defined as AUC/day below the median (quartiles 1–2). Quartile 3 excluded to highlight the differences. Trajectories estimated using LOWESS smoothing. NGT: Normal glucose tolerance.
Figure 3 –
Figure 3 –. FEV1 recovery in CFRD patients by glycemic control and treatment setting
FEV1 improvement (relative to FEV1 on admission) in CFRD patients, according to glycemic control and whether IV antibiotic treatment was finished in the hospital or at home. Poorly-controlled CFRD was defined as AUC/day in the highest quartile (quartile 4); well-controlled CFRD was defined as AUC/day below the median (quartiles 1–2). Quartile 3 excluded to highlight the differences. Trajectories estimated using LOWESS smoothing.
See this image and copyright information in PMC

References

    1. O’Sullivan BP, Freedman SD. Cystic fibrosis. Lancet. 2009;373(9678):1891–904. - PubMed
    1. Foundation CF. Cystic fibrosis foundation patient registry: 2017 annual data report 2018. 08/01/2019. Available from: https://www.cff.org/Research/Researcher-Resources/Patient-Registry/2017-....
    1. Sanders DB, Bittner RC, Rosenfeld M, Redding GJ, Goss CH. Pulmonary exacerbations are associated with subsequent FEV1 decline in both adults and children with cystic fibrosis. Pediatr Pulmonol. 2011;46(4):393–400. - PubMed
    1. Moran A, Brunzell C, Cohen RC, Katz M, Marshall BC, Onady G, et al. Clinical care guidelines for cystic fibrosis-related diabetes: a position statement of the American Diabetes Association and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society. Diabetes Care. 2010;33(12):2697–708. - PMC - PubMed
    1. Moran A, Dunitz J, Nathan B, Saeed A, Holme B, Thomas W. Cystic fibrosis-related diabetes: current trends in prevalence, incidence, and mortality. Diabetes Care. 2009;32(9):1626–31. - PMC - PubMed

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