title: Screening for Cystic Fibrosis-Related Diabetes: Matching Pathophysiology and Addressing Current Challenges.
abstract: Nearly 50% of adult patients with cystic fibrosis (CF) have diabetes. The occurrence of CF-related diabetes (CFRD) is preceded and is associated with deterioration of lung function and nutritional status. Microvascular complications can occur, but the main cause of death is respiratory failure rather than cardiovascular causes as in type 1 or type 2 diabetes. Because other methods such as glycated hemoglobin (A1C) levels are less sensitive in patients with CF, the recommended screening test is the oral glucose tolerance test (OGTT) with a 75 g glucose dose. However, OGTT is poorly suited for patients with CF, who are already facing a high disease-care burden, and appropriate CF-glucose cut-off for diagnosis and prognosis are also questioned. Thus, alternative screening methods are compared to the classical test (2-hour OGTT), including shorter OGTTs and continuous glucose monitoring. Moreover, many challenges complicate the screening for diabetes such as the complex medical care time for a patient, which is reflected by low adherence to screening tests. The best screening test should take into account the particularities of CFRD and the complexity of the CF medical care.
authors.affiliation: Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada; Department of Nutrition, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Valérie
authors.initials: V
authors.lastname: Boudreau
authors.affiliation: Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France; Department of internal medicine, Université de Lyon, Lyon, France; Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM)- Hôtel-Dieu, Montréal, Québec, Canada.
authors.forename: Quitterie
authors.initials: Q
authors.lastname: Reynaud
authors.affiliation: Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada.
authors.forename: Catherine Lehoux
authors.initials: CL
authors.lastname: Dubois
authors.affiliation: Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada.
authors.forename: Adèle
authors.initials: A
authors.lastname: Coriati
authors.affiliation: Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Desjardins
authors.affiliation: Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France; Department of internal medicine, Université de Lyon, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durieu
authors.affiliation: Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada; Department of Nutrition, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre hospitalier de l'Université de Montréal (CHUM)- Hôtel-Dieu, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada. Electronic address: remi.rabasa-lhoret@ircm.qc.ca.
authors.forename: Rémi
authors.initials: R
authors.lastname: Rabasa-Lhoret
mesh_terms: D001786:Blood Glucose; D003550:Cystic Fibrosis / Q000150:complications* / Q000503:physiopathology; D048909:Diabetes Complications / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008403:Mass Screening; D009752:Nutritional Status; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: HGPO; Intermediate time points; OGTT; Temps intermédiaires; cystic fibrosis; diabetes; diabète; fibrose kystique; screening test; test de dépistage