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Peak OGTT glucose is associated with lower lung function in young children with cystic fibrosis

Bernadette J Prentice1, Avinesh Chelliah2, Chee Y Ooi3

  • 1Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, Medicine, The University of New South Wales, Randwick, NSW, Australia; Molecular and Integrative Cystic Fibrosis Research Centre (miCF_RC), Sydney, Australia.

Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society
|May 26, 2019
PubMed

Insights

Peak glucose levels during an Oral Glucose Tolerance Test (OGTT) in children with Cystic Fibrosis (CF) correlate with poorer health outcomes. The standard 2-hour OGTT may miss early signs of CF-related diabetes (CFRD) in young patients.

Area of Science:

  • Pediatric Endocrinology
  • Cystic Fibrosis Research
  • Metabolic Disorders

Background:

  • Cystic Fibrosis-related diabetes (CFRD) screening is recommended for children under 10 with CF, particularly when growth and lung function are concerns.
  • The Oral Glucose Tolerance Test (OGTT) is the standard diagnostic tool but lacks validation in this young pediatric cohort.
  • Early detection of CFRD is crucial for managing associated health complications.

Purpose of the Study:

  • To evaluate if the 2-hour OGTT accurately detects clinical decline in children under 10 with CF.
  • To determine the association between different OGTT glucose measurements (peak vs. 2-hour) and clinical parameters like lung function and nutritional status.
  • To compare OGTT findings with Continuous Glucose Monitoring (CGM) data in this population.

Main Methods:

  • Analysis of blood glucose (BG) levels measured every 30 minutes during OGTT in 27 children with CF (<10 years old).
  • Comparison of 2-hour BG (BG120min), peak BG (BGmax), and Area Under the Curve (AUC) for glucose.
  • Correlation analysis of BG measurements with lung function (FEV1) and nutritional status (weight z-score).
  • Comparison of OGTT results with CGM data in 11 participants.

Main Results:

  • Peak BG (BGmax) was higher than BG120min in 93% of participants.
  • BGmax showed a significant inverse correlation with weight z-score (rs = -0.56, p = .002) and FEV1 (rs = -0.54, p = .014).
  • No significant correlation was found between BG120min and these clinical parameters.
  • Fasting insulin levels inversely correlated with elevated glucose on CGM (AUC >7.8 mmol/L or % time >7.8).

Conclusions:

  • Higher peak glucose levels (BGmax) during OGTT in young children with CF are associated with reduced lung function and lower weight z-scores.
  • The standard 2-hour OGTT (BG120min) may not identify these early clinical declines in children under 10.
  • Continuous Glucose Monitoring (CGM) can effectively detect glucose excursions in young children with CF, offering a potential alternative or supplementary monitoring tool.
Abstract

Keywords:
Abnormal glucose toleranceCFRDCGMChildCystic fibrosis-related diabetesGrowth

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