Diabetes

Question

Hello,
I would like to know what is the treatment for CF diabetes with high values of glucose. I have heard several opinions. Insuline or oral treatment? I have been told that oral treatments are not the best for cystic fibrosis related diabetes. What do you think?
Thank you.

Answer

Hello,
As you may know, diabetes is frequent in patients with cystic fibrosis. Depending on the fasting blood glucose test and OGTT (oral glucose tolerance test), 3 categories are defined:
• Diabetes with fasting hyperglycemia (blood glucose over 7 mmol/l)
• Diabetes without fasting hyperglycemia (blood glucose under 7 mmol/l, but OGTT 2h-blood glucose over 11 mmol/l)
• Impaired glucose tolerance (fasting blodd glucose between 6.1 and 7 mmol/l, OGTT 2h blood glucose between 7.8 and 11.1 mmol/l)
Treatments guidelines are different as the case may be.
Insulin is the only recommended medical therapy for diabetes with hyperglycemia. In the second case, all CF teams do not start immediately treatment with insulin, except if the patient demonstrates persisting signs of poor growth, inability to maintain weight, unexpected decline in pulmonary function, despite optimization of medical management.
Oral treatments are currently not recommended in CF diabetes. Nevertheless several cases have shown similar benefits between insulin and oral agents on children and adolescents. A current multicenter randomized study is comparing the role of insulin and repaglinide (oral treatment) in newly diagnosed diabetic CF patients and may better answer your question in the future.
All the best
Dr Sophie Ravilly

15.11.2010