Leclercq A, Gauthier B, Rosner V et al.
Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
J Cyst Fibros 2013 Dec 17; Epub ahead of print.
Paul Robinson’s review: Abnormal glucose metabolism is a recognized feature of advancing cystic fibrosis (CF) disease, with CF-related diabetes the most common complication at present in adult CF subjects. Several recent studies have examined the detection of the early stages of this loss of glucose homeostasis and highlighted the lack of sensitivity of oral glucose tolerance tests (OGTTs) for detecting these initial changes. In this study, the authors examined the abnormalities seen in CF subjects with normal OGTT results using the more sensitive method of continuous glucose monitoring (CGM). Relationships to clinical variables such as baseline lung function, nutrition, and Pseudomonas aeruginosa colonization status were explored.
Over a 3.5-year period at a single CF center in France, 38 patients aged ≥10 years with normal OGTT results (based on a 2-h glucose level of <7.8 mmol/L) were identified and recruited for this study, and completed 72 h of CGM. CGM was initiated within 3 months of the OGTT screening so long as there was no evidence of clinical deterioration in the interim period. There has been no standardization as to how to interpret CGM results, and a variety of different approaches have been applied in previous studies, including percentage of time above defined glucose levels. In this study, the approach taken by the authors was that subjects were classified into one of two groups depending on the presence (group 1) or absence (group 2) of at least one interstitial glucose value >11 mmol/L during CGM recording.