Clinical Characteristics and Early Treatment Patterns of Patients with Newly Diagnosed Cystic Fibrosis-Related Diabetes (CFRD)

Presentation Number: SUN 631
Date of Presentation: April 2nd, 2017

Hiba Basheer*1, Julio A Leey2, Kenneth Cusi1 and Jorge Lascano3
1University of Florida, Gainesville, FL, 2University of Florida, Gainesville, 3University of Florida

Abstract

Background: Both declining lung function and weight loss are often seen in the early stages of CFRD. Since 2010, the ADA-CFRD guidelines recommend the use of insulin for CFRD. Insulin therapy in patients with CFRD has been associated with weight gain, improved pulmonary function and survival. However, these recommendations are often not followed in clinical practice. The aim of the study was to determine the diagnostic methods used for CFRD and the prescription patterns of insulin therapy at a tertiary care center and their impact on lung function and weight loss in the early stages of CRDF (12-month after initial diagnosis

Patients and Methods: Retrospective chart review of patients newly diagnosed with CFRD at the Adult Cystic Fibrosis Center at the University of Florida, Gainesville between 2011-2015. We assessed in 19 newly diagnosed patients with CFRD plasma glucose metabolism fasting and/or during an OGTT, A1c, CF mutations, pulmonary function tests (12 months before and after diagnosis) and initial diabetes treatment during this period.

Results: The mean age of CFRD onset was 28.8±7.6 years old, with 47.3% of patients being females. Only 68% had a normal BMI while in 21% the BMI was below 20 kg/m2. Routine screening for CFRD with an OGTT led to the diagnosis in 63% of patients while in 37% it was done via A1c. The initial treatment at diagnosis in all patients was dietary intervention although one patient received metformin. Despite the recommendation to initiate insulin in CFRD, only 31% were on insulin therapy after 6 months of diagnosis and 36.8% by 12 months. In terms of nutritional status, a weight loss of at least 3% was observed in 21% of patients to the year prior to diagnosis. Two of the patients with largest weight loss (10.4% and 5.7%) started insulin therapy, their weight also improved the most within 3 months 6.5% and 3.3% respectively. Among those whom insulin was started, pulmonary function stabilized or improved within 12 months. The time from diagnosis to insulin initiation varied from 1 up to 24 months, median of 4.5 months. The initial prescriber of insulin therapy was an endocrinology provider.

Conclusion: Insulin therapy appears to be beneficial in the early stages of CFRD. Despite clinical guidelines, the use of insulin remains underutilized in CF population. Further studies are needed to identify barriers to access and patient/physician perception towards insulin therapy. Development of a multidisciplinary team that includes an endocrinologist, diabetes educator and pulmonologist is critical to CFRD management success.

 

Nothing to Disclose: HB, JAL, KC, JL