Cystic fibrosis related diabetes (CFRD) is one of the main complications of cystic fibrosis (CF), following inflammatory-degenerative damage of the pancreas. Aim of our study was to evaluate the effects of replacement insulin therapy in patients with cystic fibrosis complicated by overt diabetes or pre-diabetes on BMI and respiratory function. We selected a sample of 17 insulin treated patients (Group T) and a sample of 17 controls with CF but normal glucose metabolism (Group C). Group T was in turn subdivided into overt diabetics patients and pre-diabetics patients (impaired glucose tolerance -IGT or indetermined glucose tolerance-INDET) on the basis of the glycated hemoglobin and OGTT. For each patients in Group T an observation period was established starting with the first insulin administration and ending after 12 months. For Group C patients, a compatible year of observation was chosen to compare with the year of study of the first sample. Data regarding Body Mass Index (BMI), Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1) and Peak Expiratory Flow (PEF) were collected at time 0, and at time 12. The number of respiratory infectious episodes during the year of observation and during the preceeding year were recorded for Group T ; the same parameters were studied in the two sub-groups. The results showed a significant increase in BMI in insulin treated patients compared to controls; this response was more satisfactory in the subgroup of overt diabetics. The study of spirometric parameters shows that in treated patients there was a significant improvement of PEF, the main effort-dependent respiratory index; this result was also more evident in the subgroup of overt diabetics compared to pre-diabetics patients. This data shows a positive impact of the insulin anabolic action on the development of the thoracic musculature and on the magnitude of expiratory effort. In contrast, the study of infectious episodes revealed a reduction of the number of episodes in treated patients more evident in those with pre-diabetes. Overall, our study makes us hypothesize the advantage of insulin treatment in CF patient in the early stages of glucose alteration (IGT, INDET).
19 - 21 Sep 2019
European Society for Paediatric Endocrinology