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Does Improved Lung Health Change the Incidence of Cystic Fibrosis-Related Diabetes?
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A2842 - Does Improved Lung Health Change the Incidence of Cystic Fibrosis-Related Diabetes?
Author Block: L. Perrem, S. Stanojevic, M. Solomon, E. Horton, S. Carpenter, F. A. Ratjen; Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Introduction:
Cystic fibrosis-related diabetes (CFRD) is more commonly seen in patients with advanced disease. We hypothesized that the incidence of diabetes in paediatric patients may have changed over time as pulmonary health of CF patients has improved.
Methods:
This cohort study includes patients with CF followed at the Hospital for Sick Children from 2000 to 2016. Patients between 10 and 18 years, who were annually screened by oral glucose tolerance test, were included in this analysis with patients receiving lung transplantation censored at transplant. Patients who only manifested CFRD while on systematic steroids were excluded. Risk factors for CFRD were investigated using a nested case-control design. Each patient with CFRD was matched to four randomly selected CF patients by pancreatic status, age and year at CFRD diagnosis. Baseline for time dependent risk factors, such as FEV1 percent predicted and sputum microbiology, was the clinic visit closest to CFRD diagnosis. Univariable conditional logistic regression analyses were done to assess the association of each individual variable with CFRD. Multivariable conditional logistic regression was performed to evaluate the independent association of these variables. Incidence rates of CFRD for three consecutive time periods (2000-2004, 2005-2009 and 2010-2016) were calculated and compared using Poisson logistic regression analysis.
Results:
There were 497 patients meeting inclusion criteria during the study period. Patients with CFRD (n=37) were diagnosed at a median of 14.0 years (IQR 12.6 to 16.4 years). In the univariable analysis, compared to patients without CFRD, the CFRD group was younger at CF diagnosis (OR 3.65, p=0.026), had worse lung function (%predicted FEV1 66.5% ±21.9 vs. 77.9% ± 17.9, p=0.007), had a higher rate of allergic bronchopulmonary aspergillosis (37.5% vs. 11.8%, p=0.003) and a higher rate of sputum cultures positive for aspergillus species (35.7% vs. 14.0% p=0.002). At baseline, significantly fewer patients with CFRD had a positive culture for Staphylococcus aureus (10.7% vs. 50.9% p=0.001). All risk factors, except age at CF diagnosis, were significantly associated with CFRD in the multivariable model. There was a significant reduction in the incidence of CFRD over the consecutive study periods (p=0.02) declining from 3.19 to 1.06 per 100 patient-years.
Conclusion:
The incidence of CFRD in CF children is decreasing over time. Whether this change in incidence is causally related to improved pulmonary health associated with a lower degree of pulmonary and systemic inflammation requires further study.
Author Block: L. Perrem, S. Stanojevic, M. Solomon, E. Horton, S. Carpenter, F. A. Ratjen; Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Introduction:
Cystic fibrosis-related diabetes (CFRD) is more commonly seen in patients with advanced disease. We hypothesized that the incidence of diabetes in paediatric patients may have changed over time as pulmonary health of CF patients has improved.
Methods:
This cohort study includes patients with CF followed at the Hospital for Sick Children from 2000 to 2016. Patients between 10 and 18 years, who were annually screened by oral glucose tolerance test, were included in this analysis with patients receiving lung transplantation censored at transplant. Patients who only manifested CFRD while on systematic steroids were excluded. Risk factors for CFRD were investigated using a nested case-control design. Each patient with CFRD was matched to four randomly selected CF patients by pancreatic status, age and year at CFRD diagnosis. Baseline for time dependent risk factors, such as FEV1 percent predicted and sputum microbiology, was the clinic visit closest to CFRD diagnosis. Univariable conditional logistic regression analyses were done to assess the association of each individual variable with CFRD. Multivariable conditional logistic regression was performed to evaluate the independent association of these variables. Incidence rates of CFRD for three consecutive time periods (2000-2004, 2005-2009 and 2010-2016) were calculated and compared using Poisson logistic regression analysis.
Results:
There were 497 patients meeting inclusion criteria during the study period. Patients with CFRD (n=37) were diagnosed at a median of 14.0 years (IQR 12.6 to 16.4 years). In the univariable analysis, compared to patients without CFRD, the CFRD group was younger at CF diagnosis (OR 3.65, p=0.026), had worse lung function (%predicted FEV1 66.5% ±21.9 vs. 77.9% ± 17.9, p=0.007), had a higher rate of allergic bronchopulmonary aspergillosis (37.5% vs. 11.8%, p=0.003) and a higher rate of sputum cultures positive for aspergillus species (35.7% vs. 14.0% p=0.002). At baseline, significantly fewer patients with CFRD had a positive culture for Staphylococcus aureus (10.7% vs. 50.9% p=0.001). All risk factors, except age at CF diagnosis, were significantly associated with CFRD in the multivariable model. There was a significant reduction in the incidence of CFRD over the consecutive study periods (p=0.02) declining from 3.19 to 1.06 per 100 patient-years.
Conclusion:
The incidence of CFRD in CF children is decreasing over time. Whether this change in incidence is causally related to improved pulmonary health associated with a lower degree of pulmonary and systemic inflammation requires further study.
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