Early glucose abnormalities revealed by continuous glucose monitoring associate with lung function decline in cystic fibrosis: A five-year prospective study

• Published in: Journal of diabetes and its complications Vol. 38; no. 4; p. 108703
• Main Authors: Rakotoarisoa, Luc, Weiss, Laurence, Lefebvre, François, Porzio, Michele, Renaud-Picard, Benjamin, Ravoninjatovo, Bruno, Abely, Michel, Danner-Boucher, Isabelle, Dubois, Séverine, Troussier, Françoise, Prevotat, Anne, Rault, Gilles, Kessler, Romain, Kessler, Laurence
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2024; Elsevier Limited; Elsevier
• Subjects: Adolescent; Adult; Antibiotics; Blood Glucose; Blood Glucose Self-Monitoring; Body mass index; Child; Continuous Glucose Monitoring; Cystic fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - diagnosis; Diabetes; Diabetes Mellitus - diagnosis; Early glucose tolerance abnormalities; Expected values; Glucose; Glucose Intolerance - complications; Glucose Intolerance - diagnosis; Glucose monitoring; Humans; Hyperglycemia; Life Sciences; Lung; Lung function impairment; Metabolism; Oral glucose tolerance testing; Prospective Studies; Standard deviation; Variables; Young Adult; Continuous glucose monitoring; Cystic fibrosis; Oral glucose tolerance testing; Lung function impairment; Early glucose tolerance abnormalities
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2024.108703

Cystic fibrosis related diabetes (CFRD) is commonly associated with declining lung function and nutritional status. We aimed to evaluate the pulmonary impact of early glucose abnormalities by using 2-h standard oral glucose tolerance testing (OGTT) and continuous glucose monitoring (CGM) in people with cystic fibrosis (PwCF).
PwCF aged ≥10 years old without known CFRD were included in a five-year prospective multicentre study. Annual evaluation of nutritional status, lung function, OGTT and CGM was set up. Associations between annual rate changes (Δ) in lung function, ΔFEV1 (forced expiratory volume in 1 s) percentage predicted (pp) and ΔFVC (forced vital capacity) pp., and annual rate changes in OGTT or CGM variables were estimated with a mixed model with a random effect for subject.
From 2009 to 2016, 112 PwCF (age: 21 ± 11 years, BMI (body mass index) z-score: −0.55 ± 1.09, FEV1pp: 77 ± 24 %, 2-h OGTT glucose: 122 ± 44 mg/dL, AUC (area under curve) >140 mg/dL: 1 mg/dL/day (0.2, 3.0) were included. A total of 428 OGTTs and 480 CGMs were collected. The participants presented annual decline of FVCpp and FEV1pp at −1.0 % per year (−1.6, −0.4), p < 0.001 and − 1.9 % per year (−2.5, −1.3), p < 0.001 respectively without change in BMI z-score during the study. Variation of two-hour OGTT glucose was not associated with declining lung function, as measured by ΔFEV1pp (p = 0.94) and ΔFVCpp (p = 0.90). Among CGM variables, only increase in AUC >140 mg/dL between two annual visits was associated with a decrease in ΔFVCpp (p < 0.05) and ΔFEV1pp (p < 0.05).
This prospective study supports the fact that early glucose abnormalities revealed by CGM predict pulmonary function decline in PwCF, while 2-h standard OGTT glucose is not associated with pulmonary impairment.
•Five years prospective study of glucose tolerance in 112 people with CF without diabetes.•Impact of early glucose tolerance abnormalities at OGTT and CGM on lung function.•Repeated measures with CGM over time could help to predict lung function decline