Long-term effect of insulin treatment in cystic fibrosis-related diabetes.
BACKGROUND
Although insulin treatment confers short-term benefit in cystic fibrosis-related diabetes (CFRD), few studies have compared its long-term effect on the clinical outcome.


OBJECTIVE
In this study, we aimed to investigate the long-term impact of insulin treatment on pulmonary function, nutritional status and hospital admissions in patients with CFRD.


METHODS
We reviewed pulmonary function, body mass index (BMI) and hospital admissions 5 years before and 3 years after insulin therapy in 42 adult CFRD patients.


RESULTS
Prior to treatment, over a period of 5 years, the annual rate of change in forced expiratory volume in 1 s (FEV(1)) was -3.2%, forced vital capacity (FVC) -2.5%, and BMI -0.07%. At treatment of CFRD (baseline), the mean FEV(1) was 51.6% predicted (range 24-96), FVC 66.4% (range 29-103) and BMI 19.5 (range 15.3-29.5). At 3 months following insulin treatment, there was a significant improvement in all parameters, which was maintained at 1 year for FEV(1) (55.1%; p < 0.002), 2 years for FVC (72.1%; p < 0.01) and at 3 years for BMI (20.4%; p < 0.002). After 3 months, FEV(1) declined at a rate similar to that before treatment (-3.2 vs. -3.1% per year; p = 0.77), such that the mean FEV(1) after treatment returned to pretreatment baseline values at 34 months. There was no difference in the number of hospital admissions with insulin treatment.


CONCLUSIONS
Insulin enhances the nutritional state and temporarily improves pulmonary function in CFRD patients, on average delaying the decline in FEV(1) by 34 months.
Mohan
Kamlesh
K
Adult Cystic Fibrosis Unit, The Cardiothoracic Centre NHS Trust, Liverpool, UK.
Israel
Katherine L
KL
Miller
Helen
H
Grainger
Ruth
R
Ledson
Martin J
MJ
Walshaw
Martin J
MJ
D000293:Adolescent; D000328:Adult; D003550:Cystic Fibrosis / Q000150:complications*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008297:Male; D009752:Nutritional Status; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin