Acute hyperglycaemia in cystic fibrosis pulmonary exacerbations.
Acute hyperglycaemia in cystic fibrosis pulmonary exacerbations.
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DOI：
10.1002/edm2.208
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发表时间：
2021-04
影响因子：
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通讯作者：
Rosenfeld M
中科院分区：
文献类型：
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作者：
Merjaneh L;Toprak D;McNamara S;Nay L;Sullivan E;Rosenfeld M
高血糖症可能导致囊性纤维化（CF）患者的肺部恶化无法恢复。我们的目的是评价急性加重期间和加重后高血糖症的患病率和机制。9例未接受胰岛素治疗、因静脉注射抗生素住院的儿童CF患者在入院时（访视1）接受口服葡萄糖耐量试验（OGTT）和动态葡萄糖监测（CGM），并在基线稳定时（访视3）2周（访视2）和6周至12个月后接受OGTT。胰岛素和葡萄糖水平测定之前，30，60和120分钟后，在OGTT期间葡萄糖摄入。根据美国糖尿病协会标准，OGTT高血糖症定义为OGTT异常或与糖尿病一致。CGM高血糖定义为CGM时间高于140 mg/dL > 4.5%。在访视1时，8/9例患者在CGM和OGTT时均患有高血糖症（2例糖尿病和6例OGTT异常）。访视2时，5/8例患者出现高血糖症（均为OGTT异常）。访视3时（自访视1的中位（IQR）时间为4.9（3.8 - 6.3）个月），5/7例患者患有高血糖症（2例糖尿病和3例OGTT异常）。访视1、2和3时，平均（SD）2小时OGTT葡萄糖分别为175.8（42.3）、146.3（31.9）和176.9（51.7）mg/dL。访视1时CGM时间高于140 mg/dL的比例为25.3%（16.9）。胰岛素AUC从访视2（中位数（IQR）5449（3321 - 8123）mcIU-min/mL）降低至访视3（3234（2913 - 3680）mcIU-min/mL）。高血糖症在儿童CF急性发作期间很常见;似乎在急性发作治疗后有所改善，但随后恶化，与胰岛素分泌减少相关。在这项研究中，我们评估了囊性纤维化加重期间和之后高血糖症的患病率和机制。我们通过口服葡萄糖耐量试验和动态血糖监测发现，儿童CF急性发作时高血糖症普遍存在。急性加重治疗似乎改善，但随后恶化，与胰岛素分泌减少相关。
Hyperglycaemia may contribute to failure to recover from pulmonary exacerbations in cystic fibrosis (CF). We aimed to evaluate the prevalence and mechanism of hyperglycaemia during and post‐exacerbations. Nine paediatric CF patients, not on insulin, hospitalized for intravenous antibiotics, underwent an oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM) upon admission (visit 1) and an OGTT 2 weeks (visit 2) and 6 weeks to 12 months later when at stable baseline (visit 3). Insulin and glucose levels were measured before, 30, 60 and 120 min after glucose ingestion during OGTT. Hyperglycaemia on OGTT was defined according to the American Diabetes Association criteria as abnormal OGTT or consistent with diabetes. Hyperglycaemia on CGM was defined as CGM time above 140 mg/dL > 4.5%. At visit 1, 8/9 patients had hyperglycaemia on both CGM and OGTT (2 diabetes and 6 abnormal OGTT). At visit 2, 5/8 had hyperglycaemia (all abnormal OGTT). At visit 3, (median (IQR) time since visit 1, 4.9 (3.8‐6.3) months), 5/7 had hyperglycaemia (2 diabetes and 3 abnormal OGTT). At visits 1, 2 and 3, respectively, mean (SD) 2‐hour OGTT glucose was 175.8 (42.3), 146.3 (31.9) and 176.9 (51.7) mg/dL. CGM time above 140 mg/dL at visit 1 was 25.3% (16.9). Insulin AUC decreased from visit 2 (median (IQR) 5449 (3321‐8123) mcIU‐min/mL) to visit 3 (3234 (2913‐3680) mcIU‐min/mL). Hyperglycaemia is prevalent during paediatric CF exacerbations; it appears to improve with exacerbation treatment but to worsen later in association with decreased insulin secretion. In this study, we evaluate the prevalence and mechanism of hyperglycaemia during and post‐cystic fibrosis exacerbations. We found that hyperglycaemia is prevalent during paediatric CF exacerbations using both oral glucose tolerance tests and continuous glucose monitoring. It appears to improve with exacerbation treatment but to worsen later in association with decreased insulin secretion.