Diabetes and prediabetes in children with cystic fibrosis

Area of Science:

• Endocrinology
• Pulmonology
• Metabolic Disorders

Background:

• Glucose metabolism abnormalities, including cystic fibrosis-related diabetes (CFRD), prediabetes, and glucose intolerance, are common in cystic fibrosis (CF).
• Early and accurate classification of these glucose abnormalities is crucial for effective management.
• This review addresses recent advancements in CFRD diagnosis and therapy.

Approach:

• Review of current literature on CFRD diagnosis and treatment.
• Evaluation of the role of Oral Glucose Tolerance Test (OGTT) versus Continuous Glucose Monitoring (CGM).
• Assessment of therapeutic strategies including insulin therapy, nutritional intervention, oral hypoglycemic agents, and CFTR modulators.

Key Points:

• Oral Glucose Tolerance Test remains the gold standard for CFRD diagnosis.
• Continuous Glucose Monitoring (CGM) is valuable for therapy management but not yet diagnostic.
• Personalized insulin therapy is the recommended treatment for pediatric CFRD.
• Nutritional intervention and oral hypoglycemic agents are also effective.
• CFTR modulators improve life expectancy, pulmonary function, nutritional status, and glucose control in CF patients.

Conclusions:

• Accurate diagnosis and timely intervention are critical for managing glucose metabolism alterations in cystic fibrosis.
• Personalized therapeutic approaches, including insulin therapy and CFTR modulators, significantly improve outcomes.
• Ongoing research and technological advancements, such as CGM, will further refine CFRD management.