Cystic fibrosis related diabetes (CFRD) is commonly associated with declining lung function and nutritional status. We aimed to evaluate the pulmonary impact of early glucose abnormalities by using 2-h standard oral glucose tolerance testing (OGTT) and continuous glucose monitoring (CGM) in people with cystic fibrosis (PwCF). PwCF aged ≥10 years old without known CFRD were included in a five-year prospective multicentre study. Annual evaluation of nutritional status, lung function, OGTT and CGM was set up. Associations between annual rate changes (Δ) in lung function, ΔFEV1 (forced expiratory volume in 1 s) percentage predicted (pp) and ΔFVC (forced vital capacity) pp., and annual rate changes in OGTT or CGM variables were estimated with a mixed model with a random effect for subject. From 2009 to 2016, 112 PwCF (age: 21 ± 11 years, BMI (body mass index) z-score: −0.55 ± 1.09, FEV1pp: 77 ± 24 %, 2-h OGTT glucose: 122 ± 44 mg/dL, AUC (area under curve) >140 mg/dL: 1 mg/dL/day (0.2, 3.0) were included. A total of 428 OGTTs and 480 CGMs were collected. The participants presented annual decline of FVCpp and FEV1pp at −1.0 % per year (−1.6, −0.4), < 0.001 and − 1.9 % per year (−2.5, −1.3), p < 0.001 respectively without change in BMI z-score during the study Variation of two-hour OGTT glucose was not associated with declining lung function, as measured by ΔFEV1pp ( = 0.94) and ΔFVCpp ( = 0.90). Among CGM variables, only increase in AUC >140 mg/dL between two annual visits was associated with a decrease in ΔFVCpp ( < 0.05) and ΔFEV1pp (p < 0.05). This prospective study supports the fact that early glucose abnormalities revealed by CGM predict pulmonary function decline in PwCF, while 2-h standard OGTT glucose is not associated with pulmonary impairment.

中文翻译：

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连续血糖监测显示早期血糖异常与囊性纤维化肺功能下降相关：一项为期五年的前瞻性研究

囊性纤维化相关糖尿病（CFRD）通常与肺功能和营养状况下降有关。我们的目的是通过对囊性纤维化 (PwCF) 患者进行 2 小时标准口服葡萄糖耐量试验 (OGTT) 和连续血糖监测 (CGM) 来评估早期血糖异常对肺部的影响。年龄≥10 岁且无已知 CFRD 的 PwCF 被纳入一项为期五年的前瞻性多中心研究。每年对营养状况、肺功能、OGTT 和 CGM 进行评估。肺功能年率变化 (Δ)、ΔFEV1（1 秒用力呼气量）预测百分比 (pp) 和 ΔFVC（用力肺活量）pp. 以及 OGTT 或 CGM 变量的年率变化之间的关联通过混合估计对受试者具有随机效应的模型。从 2009 年到 2016 年，112 PwCF（年龄：21 ± 11 岁，BMI（体重指数）z 分数：−0.55 ± 1.09，FEV1pp：77 ± 24 %，2 小时 OGTT 葡萄糖：122 ± 44 mg/dL， AUC（曲线下面积）>140 mg/dL：1 mg/dL/天（0.2、3.0）。总共收集了 428 次 OGTT 和 480 次 CGM。参与者的 FVCpp 和 FEV1pp 年下降率为 -1.0 %每年 (-1.6, -0.4), < 0.001 和 - 1.9 % 每年 (-2.5, -1.3), p < 0.001 研究期间 BMI z 分数没有变化 两小时 OGTT 血糖变化不相关肺功能下降，通过 ΔFEV1pp ( = 0.94) 和 ΔFVCpp ( = 0.90) 测量。在 CGM 变量中，只有两次年度就诊之间 AUC >140 mg/dL 的增加与 ΔFVCpp ( < 0.05) 和 ΔFEV1pp 的下降相关(p < 0.05). 这项前瞻性研究支持以下事实：CGM 揭示的早期血糖异常可预测 PwCF 中的肺功能下降，而 2 小时标准 OGTT 血糖与肺功能损害无关。