Screening strategies for glucose tolerance abnormalities and diabetes in people with cystic fibrosis.

Laurence Weiss, Philippe Reix, Helen Mosnier-Pudar, Olivia Ronsin, Jacques Beltrand, Quitterie Reynaud, Laurent Mely, Pierre-Régis Burgel, Nathalie Stremler, Luc Rakotoarisoa, Alfonso Galderisi, Kevin Perge, Nathalie Bendelac, Michel Abely, Laurence Kessler

Journal: Diabetes & metabolism 2023;49(3):101444

PMID: 37030530

Full Text on Elsevier Science View on PubMed

Abstract

The increase in life expectancy of patients with cystic fibrosis has come with new comorbidities, particularly diabetes. The gradual development of glucose tolerance abnormalities means that 30 to 40% of adults will be diabetic. Cystic fibrosis-related diabetes is a major challenge in the care of these patients because it is a morbidity and mortality factor at all stages of the disease. Early glucose tolerance abnormalities observed from childhood, before the stage of diabetes, are also associated with a poor pulmonary and nutritional outcome. The long asymptomatic period justifies systematic screening with an annual oral glucose tolerance test from the age of 10 years. However, this strategy does not take into account the new clinical profiles of patients with cystic fibrosis, recent pathophysiological knowledge of glucose tolerance abnormalities, and the emergence of new diagnostic tools in diabetology. In this paper, we summarise the challenges of screening in the current context of new patient profiles - patients who are pregnant, have transplants, or are being treated with fibrosis conductance transmembrane regulator modulators - and put forward an inventory of the various screening methods for cystic fibrosis-related diabetes, including their applications, limitations and practical implications.

Address: Paediatric Cystic Fibrosis Resources and Competences Centre, Hôpitaux Universitaires de Strasbourg, France.; Paediatric Cystic Fibrosis Resources and Competences Centre, Paediatric Pulmonology and Allergology Department, Hospices Civils Lyon, France.; Department of Endocrinology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, France.; Adult Cystic Fibrosis Resources and Competences Centre, Department of Endocrinology, Diabetes and Nutrition, Hôpital Nord, CHU Marseille, France.; Paediatric Endocrinology, Gynaecology and Diabetology, Hôpital Necker Enfants-Malades, APHP Centre, Université de Paris cité, France; Inserm U1016, Institut Cochin, Paris, France.; Adult Cystic Fibrosis Resources and Competences Centre, Department of Medicine, Hospices Civils Lyon, France; Université Claude Bernard Lyon 1, RESHAPE, INSERM U1290, 69008 Lyon, France.; Mixed Cystic Fibrosis Resources and Competences Centre, Hôpital Renée Sabran, Hospices civils de Lyon, Giens, France.; National Reference Centre for Cystic Fibrosis and Pneumology Department, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, France; Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France.; Paediatric Cystic Fibrosis Resources and Competences Centre, Hôpital de la Timone, CHU de Marseille, France.; Adult Cystic Fibrosis Resources and Competences Centre, Endocrinology, Diabetes and Nutrition Department, Hôpitaux Universitaires de Strasbourg, France.; Mixed Cystic Fibrosis Resources and Competences Centre, Hôpital Américain, Reims, France.; Adult Cystic Fibrosis Resources and Competences Centre, Endocrinology, Diabetes and Nutrition Department, Hôpitaux Universitaires de Strasbourg, France; Insem UMR 1260, Regenerative Nanomedicine, Université de Strasbourg, France. Electronic address: [email protected].

DOI: 10.1016/j.diabet.2023.101444

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MeSH Terms: Adult, Humans, Child, Cystic Fibrosis, Diabetes Mellitus, Glucose Tolerance Test, Comorbidity, Glucose, Blood Glucose, Glucose Intolerance