Abnormal glucose tolerance in infants and young children with cystic fibrosis

Yaling Yi, Andrew W. Norris, Kai Wang, Xingshen Sun, Aliye Uc, Antoinette Moran, John F. Engelhardt, Katie Larson Ode

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

Rationale: In cystic fibrosis, abnormal glucose tolerance is associated with decreased lung function and worsened outcomes. Translational evidence indicates that abnormal glucose tolerance may begin in early life. Objectives: To determine whether very young children with cystic fibrosis have increased abnormal glucose tolerance prevalence compared with control subjects. The secondary objective was to compare area under the curve for glucose and insulin in children with cystic fibrosis with control subjects. Methods: This is a prospective multicenter study in children ages 3 months to 5 years with and without cystic fibrosis. Measurements and Main Results: Oral glucose tolerance testing with glucose, insulin, and C-peptide was sampled at 0, 10, 30, 60, 90, and 120 minutes. Twenty-three children with cystic fibrosis and nine control subjects had complete data. All control subjects had normal glucose tolerance. Nine of 23 subjects with cystic fibrosis had abnormal glucose tolerance (39%; P = 0.03). Of those, two met criteria for cystic fibrosis-related diabetes, two indeterminate glycemia, and six impaired glucose tolerance. Children with cystic fibrosis failed to exhibit the normal increase in area under the curve insulin with age observed in control subjects (P<0.01), despite increased area under the curve glucose (P = 0.02). Conclusions: Abnormal glucose tolerance is notably prevalent among young children with cystic fibrosis. Children with cystic fibrosis lack the normal increase in insulin secretion that occurs in early childhood despite increased glucose. These findings demonstrate that glycemic abnormalities begin very early in cystic fibrosis, possibly because of insufficient insulin secretion.

Original languageEnglish (US)
Pages (from-to)974-980
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume194
Issue number8
DOIs
StatePublished - Oct 15 2016

Bibliographical note

Funding Information:
Supported by the National Institutes of Health (NIH) grants NIDDK R24 DK96518 (J.F.E., A.W.N., and A.M.), R01 DK097820 (A.U. and A.W.N.), and P30 DK054759 (J.F.E.) and by the Fraternal Order of Eagles Diabetes Research Center Faculty Scholar Award (A.W.N.). The Institute for Clinical and Translational Science at the University of Iowa is supported by the NIH Clinical and Translational Science Award (CTSA) program, grant U54TR001356. The Clinical and Translational Science Institute at the University of Minnesota is supported through the NIH CTSA program, grant UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors thank Gretchen Cress at the University of Iowa, Iowa City, Iowa, for her help with study management.

Keywords

  • Abnormal glucose tolerance
  • Children
  • Cystic fibrosis
  • Cystic fibrosis-related diabetes mellitus
  • Infants

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