Cystic fibrosis-related diabetes

• Published in: Diabetic medicine 2003-06, Vol.20 (6), p.425-436
• Main Authors: Mackie, A. D. R., Thornton, S. J., Edenborough, F. P.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Biological and medical sciences; Breast Feeding; cystic fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - diagnosis; Cystic Fibrosis - therapy; cystic fibrosis-related diabetes; Diabetes Mellitus - diagnosis; Diabetes Mellitus - etiology; Diabetes Mellitus - therapy; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - etiology; Dietary Supplements; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Gastroenterology. Liver. Pancreas. Abdomen; Glucagon - metabolism; Glucose - administration & dosage; Glucose Intolerance - etiology; Humans; Insulin - metabolism; insulin resistance; insulin sensitivity; Islets of Langerhans - pathology; Lipid Metabolism; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Lung Transplantation; Management. Various non-drug treatments. Langerhans islet grafts; Medical sciences; microvascular complications; Nutritional Physiological Phenomena - physiology; Other diseases. Semiology; Pregnancy; Pregnancy in Diabetics - complications; Prognosis; Proteins - metabolism; Type 1 diabetes; Type 2 diabetes
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1046/j.1464-5491.2003.00924.x

Diabetes mellitus (DM) has been recognized as a complication of cystic fibrosis (CF) for almost 50 years and commonly develops around 20 years of age. The prevalence increases with age and, with improved survival of those with CF, approaches 30% in certain centres. Its development appears to have a significant impact on pulmonary function and may increase mortality by up to six‐fold. Subjects with CF are rarely ketosis‐prone and phenotypically lie between Type 1 and Type 2 DM. Microvascular complications are recognized, although paucity of data does not permit a clear description of their natural history. An annual oral glucose tolerance test from the age of 10 years is recommended for screening, but logistical difficulties have led some groups to develop specific algorithms to aid diagnosis. Insulin sensitivity in CF is much debated and may depend upon the degree of glucose intolerance. Insulin resistance occurs in the presence of infection, corticosteroid usage and hyperglycaemia, whilst hepatic insulin resistance is considered an adaptation to CF. There is no universal consensus on the treatment of hyperglycaemia. With increased longevity of individuals with CF, greater numbers will develop diabetes and the diabetes physician is destined to play a greater role in the multidisciplinary CF team. Diabet. Med. 20, 425–436 (2003)