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CF related diabetes (CFRD)

Question
Is there something a patient can do to prevent or slow down the onset of CFRD.
Answer
CFRD is a common complication in patients with Cystic Fibrosis. The frequency of CFRD increases with the patient’s age. Data from the Belgian Registry for CF show that 4.4 % of the patients in the age category 11 to 17 years are treated for diabetes, 23.4 % of the patients in the age group 18 to 24 years and 22% in the age category 25 to 44 years.
The exact cause of CFRD is not completely elucidated. Most likely the chronic and long lasting inflammation in the pancreas results in a breakdown of the insulin producing cells in the pancreas. Patients with pancreatic insufficiency who are on pancreatic enzyme replacement therapy have a higher risk of developing CFRD. Also patients with liver disease and CF seem to have a high likelihood of developing CFRD.
CFRD has a subacute onset. Only 1 in 3 patients there are complaints at the time of diagnosis that points towards diabetes. These complaints can be unexplained weight loss, increasing number of pulmonary exacerbations, unexplained worsening of lung function, frequent voiding, thirst.
As the exact cause is unknown there is no effective preventive strategy to slow down the progression towards CFRD. It is advised to pay great attention to the nutritional state and especially to avoid vitamine D deficiency. In addition it’s important to know that a timely start of diabetes management will limit the general worsening of health and lung function associated with CFRD. That is why, from adolescence on, a yearly sugar tolerance test is advised to detect diabetes timely. Of course in case of unexplained weight loss or the signs listed above, the possibility of CFRD should be considered.
Once the diagnosis of diabetes is made, a treatment with insulin should be initiated. There are many possible modalities: one or several injections a day, an insulin pump, …
Adequate control of blood sugar is important to prevent complications of CFRD such as damage to the vessels, the kidneys, the eyes. Also after the diagnosis of diabetes it is important to make sure there is a good nutritional status. That is why a sufficient intake of carbohydrates remains a necessity.
Prof. Kris De Boeck
25.06.2012