ESPE2016 Poster Presentations Diabetes P1 (72 abstracts)
The Influence of ß-Cell Autoimmunity on Cystic Fibrosis Related Diabetes Mellitus – A DPV Registry Analysis
Michael Wurm a , Nicole Prinz c, , Katja Konrad e , Katharina Laubner b , Dorothee Kieninger f , Thomas Kapellen g , Dagobert Wiemann h , Martin Schebek i , Eggert Lilienthal j , Christina Smaczny k , Michael Witsch l , Maria Bauer m & Reinhard W. Holl c,
aChildrens Hospital, University Medical Center, Freiburg, Germany; bDepartment of Internal Medicine, University Medical Center, Freiburg, Germany; cDPV registry, ZIBMT, University, Ulm, Germany; dDeutsches Zentrum für Diabetesforschung, München, Germany; eChildrens Hospital, Elisabethkrankenhaus, Essen, Germany; fChildrens Hospital, University Medical Center, Mainz, Germany; gChildrens Hospital, University Medical Center, Leipzig, Germany; hChildrens Hospital, University Medical Center, Magdeburg, Germany; iChildrens Hospital, Klinikum, Kassel, Germany; jChildrens Hospital, University Medical Center, Bochum, Germany; kChristiane Herzog CF Center, University Medical Center, Frankfurt, Germany; lChildrens Hospital, Centre Hospitalier, Luxembourg, Luxembourg; mChildrens Hospital, University Medical Center, Linz, Austria
Background: Knowledge on the role of diabetes antibodies in CF related diabetes mellitus (CFRD) is scarce.
Objective and hypotheses: We aim to inquire the relevance of ß-cell autoimmunity in CFRD.
Methods: The German/Austrian/Luxembourgian diabetes registry DPV was searched for CFRD patients. 878 individuals were analyzed by multivariable regression models.
Results: 8.7% of patients with CFRD in our cohort were positive for ß-cell autoantibodies (n=76). Analysis showed no association between antibody status and sex (females: 68.4 vs 57.2%), height (median SDS (IQR): −1.06 (−1.91–−0.164) vs −0.90 (−1.74–−0.20)) and BMI (SDS −0.81 (−1.61–−0.20) vs −1.0 (−1.80–−0.23)). Patients with ß-cell antibodies were younger at diagnosis (14.4 (11.4–16.0) vs 16.1 (13.5–20.9) years, P<0.001). After adjustment for age and sex, these patients were treated with insulin more often (92.1 vs 75.7%, P=0.003) and required higher insulin doses (0.94±0.07 vs 0.75±0.02 IU/kg/d, P=0.008). Moreover, insulin pump therapy was used more frequently (CSII 15.0 vs 6.7%, P=0.015). HbA1c differed slightly, but not significantly (7.5±0.2 vs 7.2±0.1%, P=0.10). Hypoglycemia with coma occurred in two out of 76 patients with ß-cell antibodies (eight out of 802 patients without ß-cell antibodies). Diabetic ketoacidosis was observed in three out of 76 patients with ß-cell antibodies (two out of 802 patients without ß-cell antibodies).
Conclusion: ß-cell autoantibodies are present in a relevant proportion of CFRD patients in our cohort. Onset of diabetes was earlier, insulin doses were higher and patients with ß-cell autoimmunity were treated more intensively. Nonetheless, HbA1c did not differ clinically relevant. CFRD patients with ß-cell antibodies might need a more intense therapy and should be treated with special attention.
Funding: Mukoviszidose e.V. and Federal Ministry of Education and Research within the German Competence Network for Diabetes mellitus which has been integrated in the German Center for Diabetes Research (DZD) as of January 2015.
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