AIMS: Although cystic fibrosis-related diabetes (CFRD), a poor prognostic factor in cystic fibrosis (CF), is characterized by insulinopenia, the role of insulin resistance is unclear. Using a prospective study design, we measured insulin resistance, pancreatic beta-cell function and correlated glycaemic status with clinical parameters. METHODS: Oral glucose tolerance test was performed in 60 stable adult CF patients. Insulin sensitivity and beta-cell function were measured using the homeostatic model assessment (HOMA2), Stumvoll and oral glucose insulin sensitivity (OGIS) indices. RESULTS: Forty-two (70%) had normal glucose tolerance (NGT), 10 (17%) impaired glucose tolerance (IGT) and eight (13%) CFRD. There was no difference in insulin sensitivity among the three groups (HOMA2: NGT 280, IGT 250, CFRD 339, P = 0.42; Stumvoll: NGT 0.128, IGT 0.126, CFRD 0.129, P = 0.76; and OGIS: NGT 515, IGT 472, CFRD 472, P = 0.12). Pancreatic beta-cell function (CFRD 50% vs. NGT 67%; P < 0.05) and first-phase insulin secretion were reduced in CFRD (250 vs. NGT 509; P = 0.004). First-phase insulin secretion was inversely correlated with 1-h (r = -0.74; P < 0.0001) and 2-h glucose levels (r = -0.34; P < 0.05). There was no difference in body mass index or poor lung function (forced expiratory volume in 1 s: CFRD 54% vs. NGT 65%; P = 0.43). However, there were more hospital admissions in the CFRD group (three vs. NGT one per patient per year; P < 0.05). CONCLUSIONS: CFRD is characterized by qualitative and quantitative defects in insulin secretion, but not insulin resistance, and is associated with increased hospital admissions for pulmonary exacerbations.
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机译：目的：尽管囊性纤维化相关糖尿病（CFRD）是囊性纤维化（CF）的不良预后因素，但其特征是胰岛素缺乏症，但胰岛素抵抗的作用尚不清楚。使用前瞻性研究设计，我们测量了胰岛素抵抗，胰岛β细胞功能以及血糖状态与临床参数的相关性。方法：对60名稳定的成人CF患者进行了口服葡萄糖耐量试验。使用稳态模型评估（HOMA2），Stumvoll和口服葡萄糖胰岛素敏感性（OGIS）指标测量胰岛素敏感性和β细胞功能。结果：四十二（70％）的葡萄糖耐量（NGT）正常，十（17％）的葡萄糖耐量（IGT）受损和八（13％）的CFRD。三组之间的胰岛素敏感性没有差异（HOMA2：NGT 280，IGT 250，CFRD 339，P = 0.42; Stumvoll：NGT 0.128，IGT 0.126，CFRD 0.129，P = 0.76;以及OGIS：NGT 515，IGT 472 ，CFRD 472，P ＝ 0.12）。胰岛β细胞功能（CFRD为50％，NGT为67％; P <0.05）和第一阶段胰岛素分泌在CFRD中降低（250 vs. NGT 509; P = 0.004）。第一阶段胰岛素分泌与1-h（r = -0.74; P <0.0001）和2-h葡萄糖水平（r = -0.34; P <0.05）呈负相关。体重指数或肺功能差均无差异（1秒内呼气量增加：CFRD为54％，NGT为65％; P = 0.43）。但是，CFRD组的住院人数更多（每名患者每年3例与NGT相比; P <0.05）。结论：CFRD的特征是胰岛素分泌的质量和数量缺陷，而不是胰岛素抵抗，并且与肺病急性发作的住院人数增加有关。
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