Background: Although insulin treatment confers short-term benefit in cystic fibrosis-related diabetes (CFRD), few studies have compared its long-term effect on the clinical outcome. Objectives: In this study, we aimed to investigate the long-term impact of insulin treatment on pulmonary function, nutritional status and hospital admissions in patients with CFRD. Methods: We reviewed pulmonary function, body mass index (BMI) and hospital admissions 5 years before and 3 years after insulin therapy in 42 adult CFRD patients. Results: Prior to treatment, over a period of 5 years, the annual rate of change in forced expiratory volume in 1 s (FEV1) was –3.2%, forced vital capacity (FVC) –2.5%, and BMI –0.07%. At treatment of CFRD (baseline), the mean FEV1 was 51.6% predicted (range 24–96), FVC 66.4% (range 29–103) and BMI 19.5 (range 15.3–29.5). At 3 months following insulin treatment, there was a significant improvement in all parameters, which was maintained at 1 year for FEV1 (55.1%; p < 0.002), 2 years for FVC (72.1%; p < 0.01) and at 3 years for BMI (20.4%; p < 0.002). After 3 months, FEV1 declined at a rate similar to that before treatment (–3.2 vs. –3.1% per year; p = 0.77), such that the mean FEV1 after treatment returned to pretreatment baseline values at 34 months. There was no difference in the number of hospital admissions with insulin treatment. Conclusions: Insulin enhances the nutritional state and temporarily improves pulmonary function in CFRD patients, on average delaying the decline in FEV1 by 34 months.

1.
Lanng S: Glucose intolerance in cystic fibrosis patients. Paediatr Respir Rev 2001;23:253–259.
2.
Management of cystic fibrosis related diabetes mellitus – report of the UK Cystic Fibrosis Trust Diabetes Working Group, June 2004.
3.
Lechtzin N, John M, Irizarry R, Merlo C, Diette GB, Boyle MP: Outcomes of adults with cystic fibrosis infected with antibiotic resistant Pseudomonas aeruginosa. Respiration 2006;73:27–33.
4.
Finkelstein SM, Wielinski CL, Elliott GR, Warwick WJ, Barbosa J, Wu SC, Klein DJ: Diabetes mellitus associated with cystic fibrosis. J Paediatr 1988;112:373–377.
5.
Lanng S, Thorsteinson B, Nerup J, Koch C: Influence of the development of diabetes mellitus on clinical status in patients with cystic fibrosis. Eur J Paediatr 1992;151:684–687.
6.
Dobson L, Hattersley AT, Tiley S, Elworthy S, Oades PJ, Sheldon CD: Clinical improvement in cystic fibrosis with early insulin treatment. Arch Dis Child 2002;87:430–431.
7.
Nousia-Arvanitakis S, Galli-Tsinopoulou A, Karamouzis M: Insulin improves clinical status of patients with cystic-fibrosis-related diabetes mellitus. Acta Paediatr 2001;90:515–519.
8.
World Health Organization: Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications: Report of a WHO Consultation. 1. Diagnosis and Classification of Diabetes Mellitus. Geneva, World Health Organisation, 1999.
9.
Moran A, Hardin D, Rodman D, Allen HF, Beall RJ, Borowitz D, et al: Diagnosis, screening and management of cystic fibrosis related diabetes mellitus: a consensus conference report. Diabetes Res Clin Pract 1999;45:61–73.
10.
Antibiotic treatment for cystic fibrosis – report of the UK Cystic Fibrosis Trust Diabetes Working Group, September 2002.
11.
Rafi M, Chapman K, Stewart C, Kelly E, Hanna A, Wilson DC, Tullis E, Pencharz PB: Changes in response to insulin and the effects of varying glucose tolerance on whole body protein metabolism in patients with cystic fibrosis. Am J Clin Nutr 2005;81:421–426.
12.
Goldman MD: Lung dysfunction in diabetes. Diabetes Care 2003;26:1915–1918.
13.
Ljubic S, Metelko Z, Car N, Roglic G, Drazic Z: Reduction of diffusion capacity for carbon monoxide in diabetic patients. Chest 1998;114:1033–1035.
14.
Cazzato S, Bernardi F, Salardi S, Tassinari D, Corsini I, Ragni L, Cicognani A, Cacciari E: Lung function in children with diabetes mellitus. Paediatr Pulmonol 2004;37:17–23.
15.
Brennan AL, Gyi KM, Wood DM, Johnson J, Holliman R, Baines DL, Philips B, Geddes DM, Hodson ME, Baker EH: Airway glucose concentrations and effect on growth of respiratory pathogens in cystic fibrosis. J Cyst Fibros 2007;6:101–109.
16.
Rolon MA, Benali K, Munck A, Navarro J, Clement A, Tubiana-Rufi N, Czernichow P, Polak M: Cystic fibrosis-related diabetes mellitus: clinical impact of prediabetes and effects of insulin therapy. Acta Paediatr 2001;90:860–867.
17.
Lanng S, Thorsteinsson B, Nerup J, Koch C: Diabetes mellitus in cystic fibrosis: effect of insulin therapy on lung function and infections. Acta Paediatr 1994;83:849–853.
18.
Joshi N, Caputo GM, Weitekamp MR, Karchmer AW: Infections in patients with diabetes mellitus. N Engl J Med 1999;341:1906–1912.
19.
Bizzari C, Lucidi V, Ciampalini P, Bella S, Russo B, Cappa M: Clinical effects of early treatment with insulin glargine in patients with cystic fibrosis and impaired glucose tolerance. J Endocrinol Invest 2006;29:RC1–RC4.
20.
Lanng S, Hansen A, Thorsteinsson B, Nerup J, Koch C: Glucose tolerance in patients with cystic fibrosis: five year prospective study. BMJ 1995;311:655–659.
21.
Sterescu AE, Jackson R, Dupuis A, Hanna A, Tullis E, Pencharz PB: Glucose tolerance in adult patients with cystic fibrosis: ten year prospective study (abstract). Paediatr Pulmonol 2006;29(suppl):510S.
22.
Dobson L, Sheldon CD, Hattersley AT: Conventional measures underestimate glycaemia in cystic fibrosis patients. Diabet Med 2004;21:691–696.
23.
Wagener JS, McNeill GC, Taussig LM, Corrigan JJ, Lemen R: Ferrokinetic and haematologic studies in cystic fibrosis patients. Am J Paediatr Haematol Oncol 1983;5:153–160.
24.
Farrell PM, Bieri JG, Fratantoni JF, Wood RE, Disantagnese PA: The occurrence and effects of human vitamin E deficiency. J Clin Invest 1977;60:233–241.
25.
Solomon MP, Wilson DC, Corey M, Kalnins D, Zielenski J, Tsui LC, Pencharz P, Durie P, Sweezey NB: Glucose intolerance in children with cystic fibrosis. J Pediatr 2003;142:128–132.
26.
Schaedel C, de Monestrol I, Hjelte L, Johannesson M, Kornfalt R, Lindblat A, Strandvik B, Wahlgren L, Holmberg L: Predictors of deterioration of lung function in cystic fibrosis. Pediatr Pulmonol 2002;33:483–491.
27.
Conway S, Pond MN, Hamnett T, Watson A: Compliance with treatment in adult patients with cystic fibrosis. Thorax 1996;51:29–33.
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