title: Sensitivity and specificity of different methods for cystic fibrosis-related diabetes screening: is the oral glucose tolerance test still the standard?
abstract: BACKGROUND
  Cystic fibrosis-related diabetes (CFRD) is a late cystic fibrosis (CF)-associated comorbidity whose prevalence is increasing sharply lifelong. Guidelines for glucose metabolism (GM) monitoring rely on the oral glucose tolerance test (OGTT). However, this test is neither sensitive nor specific. The aim of this study was to compare sensitivity and specificity of different methods for GM monitoring in children and adolescents with CF.
  
  
  METHODS
  Continuous glucose monitoring system (CGMS), used as the reference method, was compared with the OGTT, intravenous glucose tolerance test (IGTT), homeostasis model assessment index of insulin resistance (HOMA-IR), homeostasis model assessment index of β-cell function (HOMA-%B) and glycated haemoglobin A1C. Patients were classified into three groups according to CGMS: normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes mellitus (DM).
  
  
  RESULTS
  Twenty-nine patients (median age: 13.1 years) were recruited. According to CGMS, 11 had DM, 12 IGT and six NGT, whereas OGTT identified three patients with DM and five with IGT. While 13 of 27 had insulin deficiency according to IGTT, there was 19 of 28 according to HOMA-%B. According to HOMA-IR, 12 of 28 had insulin resistance. HOMA-%B was the most sensitive method for CFRD screening [sensitivity 91% (95% CI), specificity 47% (95% CI) and negative predictive value 89% (95% CI)].
  
  
  CONCLUSIONS
  OGTT showed the weak capacity to diagnose DM in CF and should no longer be considered as the reference method for CFRD screening in patients with CF. In our study, HOMA-%B showed promising metrics for CFRD screening. Finally, CGMS revealed that pathological glucose excursions were frequent even early in life.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mainguy
authors.forename: Gabriel
authors.initials: G
authors.lastname: Bellon
authors.forename: Véronique
authors.initials: V
authors.lastname: Delaup
authors.forename: Tiphanie
authors.initials: T
authors.lastname: Ginoux
authors.forename: Behrouz
authors.initials: B
authors.lastname: Kassai-Koupai
authors.forename: Stéphane
authors.initials: S
authors.lastname: Mazur
authors.forename: Muriel
authors.initials: M
authors.lastname: Rabilloud
authors.forename: Laurent
authors.initials: L
authors.lastname: Remontet
authors.forename: Philippe
authors.initials: P
authors.lastname: Reix
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000032:analysis*; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000150:complications / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D018149:Glucose Intolerance / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005951:Glucose Tolerance Test / Q000379:methods*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human