Abnormal glucose tolerance in children with cystic fibrosis: the predictive role of continuous glucose monitoring system.
A long pre-diabetic phase of abnormal glucose tolerance is described in subjects with cystic fibrosis (CF) since childhood.


OBJECTIVE
The aims of the study were to compare oral glucose tolerance test (OGTT) and continuous glucose monitoring system (CGMS) in the diagnosis of altered glucose metabolism, and to longitudinally evaluate the role of CGMS in predicting glucose metabolism deterioration in children with CF.


METHODS
Seventeen children with CF and 14 controls were enrolled (mean age 13.3+/-3.0 years). All subjects underwent OGTT and CGMS registration. On the basis of OGTT, children were classified as normal glucose tolerance, impaired glucose tolerance (IGT), IGT plus at least one glucose value above 200 mg/dl at intermediate OGTT points (IGT+200) and CF-related diabetes (CFRD). HbA1c, glucose area under the curve, insulin sensitivity, and insulinogenic and disposition indexes were also considered. Subjects with CF underwent another OGTT after 2.5 years.


RESULTS
Baseline OGTT revealed 3/17 (7.6%) children with CF with at least one glucose value above 200 mg/dl (1 CFRD and 2 IGT+200), while CGMS revealed 6/17 (35.3%) children with glucose excursions above 200 mg/dl (P=0.010). None of the controls showed glucose over 200 mg/dl either at OGTT or at CGMS. At the 2.5-year follow-up OGTT, all the six subjects who had diabetic glucose excursion (i.e. >200 mg/dl) at baseline CGMS presented IGT+200 or CFRD. In logistic regression analysis, CGMS diabetic excursion was the strongest predictor of IGT+200 and CFRD (P<0.001).


CONCLUSIONS
CGMS could be a useful tool to predict glucose metabolism derangements in children affected by CF.
Schiaffini
Riccardo
R
Endocrinology and Diabetes Unit, University Department of Paediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Piazza S Onofrio 4, 00165 Rome, Italy.
Brufani
Claudia
C
Russo
Beatrice
B
Fintini
Danilo
D
Migliaccio
Antonella
A
Pecorelli
Lia
L
Bizzarri
Carla
C
Lucidi
Vincenzina
V
Cappa
Marco
M
D000293:Adolescent; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D002648:Child; D003550:Cystic Fibrosis / Q000097:blood*; D005260:Female; D018149:Glucose Intolerance / Q000097:blood*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin