title: Influence of macrolides, nutritional support and respiratory therapies in diabetes and normal glucose tolerance in cystic fibrosis. A retrospective analysis of a cohort of adult and younger patients.
abstract: OBJECTIVE
  The development of cystic fibrosis related diabetes is associated with increased morbidity and mortality, worse nutritional status and lung function decline. It is known that patients with cystic fibrosis have a chronic inflammation status and that β pancreatic cells are very sensitive to oxidative stress. So these inflammatory mediators could contribute to the onset of progressive pancreatic fibrosis and, hence, to impair glucose metabolism. So, it could be hypothesized that the treatment with macrolides would protect and preserve β-cell function by decreasing pro-inflammatory cytokines and free oxidative radicals.
  
  
  METHODS
  We retrospectively analyzed a cohort of 64 patients affected of cystic fibrosis, older than 14 years, by using the first pathological 2-h oral glucose tolerance test; peripheral insulin resistance was calculated using the homeostasis model assessment for insulin resistance (HOMA - IR) and pancreatic β-cell function was estimated according to Wareham. The influence of macrolides, microbiological colonization, nutritional support and related clinical parameters were analyzed.
  
  
  RESULTS
  Comparing CFRD without FPG and NGT, and after adjustment for microbial colonization, the significance of the use of macrolides was lost (p=0.1), as a risk or protective factor for any of the studied groups. Non-significative associations were found in the use of macrolides, inhaled corticosteroids and nutritional support therapies within the different disorders of carbohydrate metabolism.
  
  
  CONCLUSIONS
  The anti-inflammatory and immunomodulating effect of macrolides did not seem to affect the β cell function or insulin resistance in patients with cystic fibrosis. The use of inhaled corticosteroids or nutritional supplements have not any influence in the carbohydrate metabolism. Further prospective studies are needed to analyze a potential protective role of macrolides in the development of carbohydrate metabolism alterations in cystic fibrosis.
authors.affiliation: Endocrinology Department, University hospital Ramón y Cajal. Ctra, Colmenar Viejo 9,1 Km, C.P. 28034 Madrid, Spain. Electronic address: mcanomegias@gmail.com.
authors.forename: Marta Cano
authors.initials: MC
authors.lastname: Megías
authors.affiliation: Endocrinology Department, University hospital Ramón y Cajal. Ctra, Colmenar Viejo 9,1 Km, C.P. 28034 Madrid, Spain. Electronic address: olgagonzalezalbarran@gmail.com.
authors.forename: Olga González
authors.initials: OG
authors.lastname: Albarrán
authors.affiliation: Internal Medicine Department, Hospital Quirón San Camilo, C/ Juan Bravo no 39, C.P. 2006 Madrid, Spain. Electronic address: pablogvasco@gmail.com.
authors.forename: Pablo Guisado
authors.initials: PG
authors.lastname: Vasco
authors.affiliation: Paediatrics Department, Cystic Fibrosis Unit, University hospital Ramón y Cajal. Ctra, Colmenar Viejo 9,1 Km, C.P. 28034 Madrid, Spain. Electronic address: alamasf.hrc@salud.madrid.org.
authors.forename: Adelaida Lamas
authors.initials: AL
authors.lastname: Ferreiro
authors.affiliation: Pneumology Department, University hospital Ramón y Cajal. Ctra, Colmenar Viejo 9, 1 Km, C.P. 28034 Madrid, Spain. Electronic address: lmaiz.hrc@salud.madrid.org.
authors.forename: Luis Maiz
authors.initials: LM
authors.lastname: Carro
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D003550:Cystic Fibrosis / Q000097:blood / Q000150:complications / Q000378:metabolism* / Q000628:therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000209:etiology / Q000378:metabolism* / Q000628:therapy*; D004040:Dietary Carbohydrates / Q000378:metabolism; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D007333:Insulin Resistance; D007515:Islets of Langerhans / Q000378:metabolism*; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D018529:Nutritional Support; D018384:Oxidative Stress; D012138:Respiratory Therapy; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D004040:Dietary Carbohydrates; D018942:Macrolides
keywords: Cystic fibrosis; Diabetes; Insulin resistance; Macrolides; Nutritional supplements; β-Cell function