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Glucose tolerance & insulin secretion & sensitivity characteristics in Indian children with cystic fibrosis: A pilot
Vandana Jain1, Santosh Kumar1, Naval K Vikram2
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Cystic fibrosis (CF) affects glucose tolerance in Indian children, with over 21% showing abnormal glucose tolerance. These children exhibit significantly lower insulin sensitivity, highlighting a key metabolic complication in CF.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Genetic Diseases
Background:
- Cystic fibrosis (CF) is a serious genetic disorder impacting multiple organs, including the pancreas.
- Chronic infections and nutritional deficiencies are common in CF patients.
- Metabolic complications like glucose intolerance are increasingly recognized in CF.
Purpose of the Study:
- To evaluate glucose tolerance and insulin dynamics in Indian children with CF.
- To assess insulin secretion and sensitivity in this pediatric population.
- To identify potential metabolic abnormalities associated with CF in Indian children.
Main Methods:
- A pilot study enrolled 29 Indian children with CF undergoing regular follow-up.
- Exclusion criteria included recent acute exacerbations or steroid use.
- Assessed anthropometry, pulmonary function, disease severity, and performed oral glucose tolerance tests with insulin measurements.
Main Results:
- Abnormal glucose tolerance (AGT) was found in 21.4% of the children.
- Patients with AGT had significantly lower insulin sensitivity compared to those with normal glucose tolerance (NGT).
- Insulin secretion was comparable between AGT and NGT groups, but insulin resistance was higher in the AGT group.
Conclusions:
- Over one-fifth of Indian children with CF in this study exhibited abnormal glucose tolerance.
- Reduced insulin sensitivity is a significant finding in CF patients with AGT.
- Further large-scale, multicenter studies are recommended to confirm these findings and compare with healthy controls.
Background & Objectives:
Cystic fibrosis (CF) is a life-limiting genetic condition resulting in chronic respiratory infections, pancreatic enzyme insufficiency and associated complications. This pilot study was undertaken to assess the glucose tolerance and insulin secretion and sensitivity among Indian children with CF.
Methods:
Children with CF under regular follow up at the Paediatric Pulmonology Clinic of a tertiary care hospital in New Delhi, India, were enrolled. Children who had a history of acute exacerbation or intake of systemic steroids within the last two weeks were excluded. Anthropometry, pulmonary function and disease severity (Shwachman) score were assessed. Fasting venous sample was drawn to assess glucose, insulin, haemoglobin and calcium. Oral glucose tolerance test was performed, and blood glucose and insulin were assessed at 30, 60, 90 and 120 min. Insulin secretion and sensitivity indices were calculated.
Results:
Twenty nine patients with a mean age of 11.2±4.1 yr were enrolled. Stunting, thinness, anaemia and hypocalcaemia were present in 31.0, 13.8, 37.0 and 48.3 per cent of the patients, respectively. Abnormal glucose tolerance (AGT) was present in 21.4 per cent. Insulin secretion was similar in individuals with AGT and normal glucose tolerance (NGT), but insulin sensitivity index was lower (0.12±0.02 vs 0.15±0.01, P<0.001) and homeostatic model assessment of insulin resistance higher [1.63 (0.53-1.76) vs 0.83 (0.28-4.43), P<0.05] in individuals with AGT compared to NGT.
Interpretation & Conclusions:
AGT was observed in 21.4 per cent of children with CF. The CF patients with AGT had significantly lower insulin sensitivity compared to patients with NGT. Future multicentric studies with a large sample should be conducted to assess insulin secretion and sensitivity indices in CF patients compared to healthy controls.
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