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Glucose intolerance in children with cystic fibrosis: a developing country's perspective
Lakshmipathi Naik Banavath1, Rakesh Kumar1, Devi Dayal1
1Pediatric Endocrinology and Diabetes Division, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India.
Insights
Cystic fibrosis-related diabetes (CFRD) affects many children with cystic fibrosis (CF), with abnormal glucose tolerance (AGT) prevalent in those over 3 years with CF or over 6 years old. Annual screening is recommended.
Area of Science:
- Pediatrics
- Endocrinology
- Pulmonology
Background:
- Cystic fibrosis-related diabetes (CFRD) is a frequent complication in cystic fibrosis (CF) patients.
- Limited data exists on glucose intolerance in pediatric CF patients from developing nations.
Purpose of the Study:
- To determine the prevalence of abnormal glucose tolerance (AGT) in children with CF.
- To investigate the relationship between AGT and CF duration and severity.
Main Methods:
- Oral glucose tolerance tests (OGTT) were administered to 25 children (2-18 years) with CF for at least 6 months.
- Two-hour plasma glucose levels were correlated with CF duration, age, and hospitalization frequency.
Main Results:
- AGT was detected in 64% (16/25) of children, including 12% (3/25) with CFRD.
- Children with CF for over 3 years showed a higher AGT prevalence (81.8%) compared to those with shorter duration.
- AGT correlated positively with CF duration and the number of hospitalizations for acute pulmonary exacerbations.
Conclusions:
- The majority of children with CF for over 3 years or over 6 years of age develop AGT.
- Annual OGTT screening for early AGT detection is suggested for children with CF.
Abstract:
Background Cystic fibrosis-related diabetes (CFRD) is a common comorbidity reported in patients with cystic fibrosis (CF). There is a dearth of data on glucose intolerance or CFRD in children with CF from developing countries. So, we planned to study the prevalence of abnormal glucose tolerance (AGT) in children with CF and its relation with the duration and severity of CF. Methods We performed an oral glucose tolerance test (OGTT) on children (2-18 years old) having CF for at least 6 months. Two-hour plasma glucose levels on OGTT were correlated with various disease-related factors. Results Out of the 25 children enrolled, there were 18 boys and seven girls. The mean age and duration of CF were 7.9±4.3 and 3.16±2.5 years, respectively. AGT was observed in 16 (64%) children with CF including three (12%) children with CFRD. Children with a duration of CF of 3 years had significantly higher prevalence (81.8%) of AGT when compared with duration ≤3 years (p-value<0.05). Twelve out of 17 (70.6%) children were colonized with Pseudomonas and 12 out of 15 (80%) children >6 years of age had AGT. There was a positive correlation of 2-h glucose value on OGTT with duration of CF and number of hospitalizations with acute pulmonary exacerbations. Conclusions The majority of children having CF for >3 years and/or age >6 years developed AGT. In our clinical setting, an annual screening with OGTT to detect AGT may be required at an early age and duration of CF.