Conventional measures underestimate glycaemia in cystic fibrosis patients
Conventional measures underestimate glycaemia in cystic fibrosis patients
复制标题
DOI：
10.1111/j.1464-5491.2004.01219.x
复制
发表时间：
2004-07-01
影响因子：
3.5
通讯作者：
Hattersley, AT
中科院分区：
文献类型：
--
作者：
Dobson, L;Sheldon, CD;Hattersley, AT
目的 糖尿病是囊性纤维化 (CF) 日益重要的并发症。囊性纤维化相关糖尿病 (CFRD) 发病率增加的相关性强调了对所有 CF 患者进行准确血糖监测的必要性。该诊断依赖于非 CF 受试者流行病学研究得出的口服葡萄糖耐量试验 (OGTT) 的常规阈值。然而，尚未确定这些值在 CF 和非 CF 人群中是否相等。方法我们使用 HbA(1c)、OGTT 和测量间质葡萄糖水平的皮下连续血糖监测系统 (CGMS) 比较了 21 名非糖尿病 CF 受试者与 21 岁和 BMI 匹配的非 CF 对照的血糖。结果 两组的血糖相似：HbA(1c) 平均 CF 与对照组相比（5.5 vs. 5.3%P = 0.4）、空腹血糖（4.8 vs. 4.7 mmol/l P = 0.7）和 2 小时血糖（5.8 vs. 5.7 mmol/l P = 0.8）。然而，这些常规测量方法并不能准确反映 30 分钟、60 分钟和 90 分钟的血糖。 CF 受试者的葡萄糖值和 OGTT 曲线下面积均高于对照组 (P = 0.01-0.0001)。 CF 受试者的平均 CGMS 值 [5.9 (0.8) vs. 5.1 (0.5) mmol/l，P = 0.004] 以及 CGMS 峰值值 > 11.1 mmol/l (33 vs. 5%P = 0.00001) 的受试者比例也高于对照组。当仅对两组中糖耐量正常的受试者进行研究时，这些结果仍然存在显着差异。 结论 我们已经表明，如 OGTT 和 CGMS 期间的反应所示，具有相似 HbA(1c)、空腹和 2 小时血糖值的 CF 受试者的总体血糖较高。这些结果质疑使用来自非 CF 人群的诊断阈值和 OGTT 时间点来诊断囊性纤维化患者的糖尿病是否合适。
Aims Diabetes mellitus is an increasingly important complication of cystic fibrosis (CF). The association with increased morbidity of cystic fibrosis-related diabetes (CFRD) has emphasized the need for accurate monitoring of glycaemia in all CF patients. The diagnosis has relied on conventional thresholds in an oral glucose tolerance test (OGTT) derived from epidemiological studies in non-CF subjects. However, it has not been established if these values are equivalent in CF and non-CF populations.Methods We compared glycaemia in 21 non-diabetic CF subjects with 21-age and BMI-matched non-CF controls using HbA(1c), OGTT and a subcutaneous continuous glucose monitoring system (CGMS) that measures interstitial glucose levels.Results All conventional measures of glycaemia were similar in the two groups: HbA(1c) mean CF vs. controls (5.5 vs. 5.3%P = 0.4), fasting glucose (4.8 vs. 4.7 mmol/l P = 0.7) and 2-h glucose (5.8 vs. 5.7 mmol/l P = 0.8). However, these conventional measures did not accurately reflect glycaemia 30-, 60- and 90-min. Glucose values and area under the curve in OGTT were all higher in CF subjects than controls (P = 0.01-0.0001). Mean CGMS value [5.9 (0.8) vs. 5.1 (0.5) mmol/l, P = 0.004], and the proportion of subjects with peak CGMS values > 11.1 mmol/l (33 vs. 5%P = 0.00001) were also higher in CF subjects than controls. These results remained significantly different when only subjects with normal glucose tolerance in the two groups were studied.Conclusions We have shown that overall glycaemia, as shown by both the response during an OGTT and CGMS, is higher in CF subjects who have similar HbA(1c), fasting and 2-h glucose values. These results question whether it is appropriate to use the diagnostic thresholds and OGTT time points derived from the non-CF population for a diagnosis of diabetes in patients with cystic fibrosis.