Frequency of Disorders of Carbohydrate Metabolism in Patients with Cystic Fibrosis Treated at Mexico Nacional Institute of Pediatrics

Presentation Number: MON 599
Date of Presentation: April 3rd, 2017

Carla Jeorgina Borda Riveros*1, Gina Maria Rivera2, Pilar Paola Palacio2, Aidy González Nuñez2, Alexandra Vimos Tixi1, Elisa Maria Vazquez2, Ana Gabriela Garibay2, Arturo del Monte3, Nicole Maheva Monteverde1, LLuvia Vianey Fajardo2, Christian Daniel Alvarado Araiza2, Lissette Arguinzoniz1, Maria de la Luz Ruiz Reyes2, Raúl Calzada León2, Carlos Robles4 and Nelly Altamirano5
1Instituto Nacional de Pediatría, Mexico City, Mexico, 2Instituto Nacional de Pediatria, Mexico, Mexico, 3Instituto Nacional de Pedaitria, Mexico, Mexico, 4Instituto Nacional de Pediatria, Mexico City, Mexico, 5Instituto Nacional de Pediatria, Distrito Federal, Mexico

Abstract

Diabetes is a common comorbidity of Cystic Fibrosis, the pathophysiology of this disturbance includes the loss of pancreatic islet cells leading to both insulin and glucagon deficiency, fluctuating insulin resistance (IR), the requirement for high caloric intake, gut abnormalities including delayed gastric emptying, altered intestinal motility, and liver disease1,2,3. The onset of diabetes typically occurs in the second decade of life but a prediabetes stage is frequently present.2,4 There are few publications about glucose abnormalities in children less than 10 years old. To determine the frequency of disorders of carbohydrate metabolism in patients with Cystic Fibrosis, we performed the oral glucose tolerance test (OGTT) in patient between 6 and 18 years old, from February 1st, 2016 to February 1st, 2018. The latter was accomplished by an observational, descriptive and cross sectional study, in which we determine venous blood glucose and blood insulin levels at 0, 30 and 120 minutes, and capillary blood glucose at minutes 0, 30, 60, 90 and 120. In the preliminary results of the first 7 months of this 2 years study we included 20 patients. The median age of the patients was 10,6 years (95% CI 8.7-12.39). The results were analysed in two groups: group 1 included patients with age <= 10 years; group 2 included patients with age >10 years. All the patients had normal fasting blood glucose level, 10% of all patients had impaired glucose tolerance (IGT); when were analysed by age, the group 1 had 8.3% while the group 2 had 12.5% of IGT. After analysing blood glucose levels at minute 30, 60 and 90, an indeterminate glucose tolerance (INDET) was observed in 65% of the patients, 66.6% in group 1 and 62.5% in group 2. IR was determined through HOMA index in 10% of all the patients, in 8.3% of the group 1 and 12.5% of the group 2. None of the patients were diagnosed with diabetes. Overall results demonstrate that IGT and insulin resistance was more frequent in patients older than 10 years. The INDET results was the more frequent metabolic alteration in analysed children, but in younger than 10 years old this was higher than older than 10 years old. However, in the meantime we recommend that even though the patient does not meet the diagnostic criteria for diabetes, it is necessary to evaluate the benefits of insulin therapy in patients with inadequate progression of weight, height and impaired pulmonary function, then each case should be individualized.

 

Nothing to Disclose: CJB, GMR, PPP, AG, AV, EMV, AGG, AD, NMM, LVF, CDA, LA, MDLLR, RC, CR, NA