One-year glargine treatment can improve the course of lung disease in children and adolescents with cystic fibrosis and early glucose derangements

Authors


Enza Mozzillo
Department of Pediatrics
Federico II University of Naples
via S. Pansini, 5
80131 Napoli
Italy.
Tel: +39 081 7464234;
fax: +39 081 7464234;
e-mail: enzamozzillo@libero.it

Abstract

Background:  Diabetes increases morbidity and mortality in cystic fibrosis (CF) patients, but several studies indicate that also prediabetic status may have a potential impact on both nutrition and lung function.

Objective:  To evaluate the effect of glargine on the clinical course in CF patients with early glucose derangements.

Methods:  CF population was screened for glucose tolerance. CF patients with age >10 yr were screened with fasting hyperglycemia (FH). CF patients with age >10 yr without FH and those with age <10 yr with occasional FH were evaluated for glucose abnormalities on the basis of oral glucose tolerance test and/or continuous glucose monitoring system. All CF patients with glucose derangements were enrolled in an open clinical trial with glargine. Body mass index (BMI) z-score, forced expiratory volume in the first second (FEV1), number of acute pulmonary exacerbations and hemoglobin A1c, were as outcome measures at baseline and after 1 yr of treatment.

Results:  After 12 months of therapy, BMI z-score improved only in patients with baseline BMI z-score less than −1 (p = 0.017). An 8.8% increase in FEV1 (p = 0.01) and 42% decrease in the number of pulmonary exacerbations (p = 0.003) were found in the whole group compared with previous 12 months of therapy.

Conclusion:  Glargine could represent an innovative strategy to prevent lung disease progression in CF patients with early glucose derangements. Larger controlled trials are needed to better clarify the effects of insulin on clinical status in CF patients with early glucose derangements.

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