title: Advances in the detection and management of cystic fibrosis related diabetes.
abstract: OBJECTIVE
  This review will outline the screening, diagnosis and management of cystic fibrosis related diabetes (CFRD). It will also discuss advances in the detection of early glucose abnormalities, their clinical significance and the emerging role for early insulin therapy.
  
  
  RESULTS
  Before the onset of diabetes (as currently defined), patients with cystic fibrosis (CF) display glucose abnormalities, detectable either by 30-minutely sampled oral glucose tolerance testing (OGTT), or by continuous ambulatory interstitial glucose monitoring (CGM). These early glucose abnormalities are associated with the presence of glucose in airway fluid, potentially promoting the growth of airway pathogens and contributing to the progression of respiratory disease. Progressive insulin deficiency underlies these glucose abnormalities, and insulin deficiency also causes catabolism. Pilot studies of once-daily insulin therapy in the early stages of insulin deficiency show improved lung function and weight gain (important predictors of survival in CF).
  
  
  CONCLUSIONS
  Early stages of insulin deficiency may be contributing to catabolism and deteriorating lung function in CF. It is plausible that early insulin therapy may prevent this deterioration, a view supported by pilot studies. Randomized controlled trials of early insulin therapy will now determine whether insulin therapy should be commenced earlier than current practice in CF.
authors.affiliation: aEndocrinology Department, Sydney Children's Hospital, Randwick bSchool of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Shihab
authors.initials: S
authors.lastname: Hameed
authors.forename: Adam
authors.initials: A
authors.lastname: Jaffé
authors.forename: Charles F
authors.initials: CF
authors.lastname: Verge
mesh_terms: D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D003920:Diabetes Mellitus / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D042241:Early Diagnosis; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use*; D008991:Monitoring, Physiologic; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D012129:Respiratory Function Tests; D015430:Weight Gain
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin