Katja Konrad1, Thomas Kapellen2, Eggert Lilienthal3, Nicole Prinz4, Maria Bauer5, Angelika Thon6, Ernst Rietschel7, Dagobert Wiemann8, Reinhard W Holl9. 1. Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany k.konrad@contilia.de. 2. Department of Pediatrics, University of Leipzig, Leipzig, Germany. 3. Department of Pediatrics, University of Bochum, Bochum, Germany. 4. Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany. 5. Department of Pediatric and Adolescent Medicine, University of Linz, Linz, Austria. 6. Department of Pediatrics, Hannover Medical School, Hannover, Germany. 7. Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany. 8. Department of Pediatrics, University of Magdeburg, Magdeburg, Germany. 9. Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany German Center for Diabetes Research, München-Neuherberg, Germany.
Abstract
OBJECTIVE: Research on β-cell autoimmunity in cystic fibrosis (CF)-related diabetes (CFRD) is still rare. We aimed to analyze the frequency of β-cell autoimmunity and the influence on age at diabetes onset, insulin requirement, type of insulin therapy, and hypoglycemic or ketoacidotic events in patients with CFRD compared with antibody-negative patients with CFRD in the Diabetes Patienten Verlaufsdokumentation (DPV) registry. RESEARCH DESIGN AND METHODS: We analyzed data of 837 patients with CFRD in the German/Austrian DPV database by multivariable mixed-regression modeling. RESULTS: In our cohort, 8.5% of patients with CFRD (n = 72) were found to be β-cell antibody positive. There was a female preponderance in this patient group: 65.3 vs. 57.6%. Diabetes onset (median [interquartile range]) was earlier (14.00 [10.15-15.90] vs. 16.10 [13.50-21.20] years; P < 0.005), and insulin dose/kg body weight was higher (0.95 [0.61-1.15] vs. 0.67 [0.33-1.04] IU/kg; P < 0.05). There were also differences in the type of insulin treatment. Insulin pump therapy was used significantly more often in patients with CFRD with β-cell autoimmunity (18.2 vs. 6.4%; P < 0.05). The differences for multiple daily injections (ICT) and conventional therapy (CT) were not significant (ICT: 67.7 vs. 79.0%; CT: 15.2 vs. 14.6). Oral antidiabetic agents were rarely used in both groups. Rate of severe hypoglycemia with coma and rate of ketoacidosis were higher in antibody-positive patients (hypoglycemia with coma: 8.0 vs. 1.4, P < 0.05; ketoacidosis: 9.3 vs. 0.9, P < 0.05). CONCLUSIONS: Presence of β-cell autoantibodies in our cohort of patients with CFRD (8.5%) appeared to be greater than in the general population and was associated with female sex, earlier onset of diabetes, and higher insulin requirement. Insulin pump therapy was used significantly more often in patients with β-cell antibodies. Severe hypoglycemia and ketoacidosis were significantly more frequent in CFRD with β-cell autoimmunity compared with β-cell antibody-negative patients with CFRD.
OBJECTIVE: Research on β-cell autoimmunity in cystic fibrosis (CF)-related diabetes (CFRD) is still rare. We aimed to analyze the frequency of β-cell autoimmunity and the influence on age at diabetes onset, insulin requirement, type of insulin therapy, and hypoglycemic or ketoacidotic events in patients with CFRD compared with antibody-negative patients with CFRD in the Diabetes Patienten Verlaufsdokumentation (DPV) registry. RESEARCH DESIGN AND METHODS: We analyzed data of 837 patients with CFRD in the German/Austrian DPV database by multivariable mixed-regression modeling. RESULTS: In our cohort, 8.5% of patients with CFRD (n = 72) were found to be β-cell antibody positive. There was a female preponderance in this patient group: 65.3 vs. 57.6%. Diabetes onset (median [interquartile range]) was earlier (14.00 [10.15-15.90] vs. 16.10 [13.50-21.20] years; P < 0.005), and insulin dose/kg body weight was higher (0.95 [0.61-1.15] vs. 0.67 [0.33-1.04] IU/kg; P < 0.05). There were also differences in the type of insulin treatment. Insulin pump therapy was used significantly more often in patients with CFRD with β-cell autoimmunity (18.2 vs. 6.4%; P < 0.05). The differences for multiple daily injections (ICT) and conventional therapy (CT) were not significant (ICT: 67.7 vs. 79.0%; CT: 15.2 vs. 14.6). Oral antidiabetic agents were rarely used in both groups. Rate of severe hypoglycemia with coma and rate of ketoacidosis were higher in antibody-positive patients (hypoglycemia with coma: 8.0 vs. 1.4, P < 0.05; ketoacidosis: 9.3 vs. 0.9, P < 0.05). CONCLUSIONS: Presence of β-cell autoantibodies in our cohort of patients with CFRD (8.5%) appeared to be greater than in the general population and was associated with female sex, earlier onset of diabetes, and higher insulin requirement. Insulin pump therapy was used significantly more often in patients with β-cell antibodies. Severe hypoglycemia and ketoacidosis were significantly more frequent in CFRD with β-cell autoimmunity compared with β-cell antibody-negative patients with CFRD.
Authors: Rebecca L Hull; Ronald L Gibson; Sharon McNamara; Gail H Deutsch; Corinne L Fligner; Charles W Frevert; Bonnie W Ramsey; Srinath Sanda Journal: Diabetes Care Date: 2018-02-01 Impact factor: 19.112
Authors: Melena D Bellin; David C Whitcomb; Judah Abberbock; Stuart Sherman; Bimaljit S Sandhu; Timothy B Gardner; Michelle A Anderson; Michele D Lewis; Samer Alkaade; Vikesh K Singh; John Baillie; Peter A Banks; Darwin Conwell; Gregory A Cote; Nalini M Guda; Thiruvengadam Muniraj; Gong Tang; Randall E Brand; Andres Gelrud; Stephen T Amann; Christopher E Forsmark; C Mel Wilcox; Adam Slivka; Dhiraj Yadav Journal: Am J Gastroenterol Date: 2017-07-25 Impact factor: 10.864
Authors: Melena D Bellin; Mark Lowe; M Bridget Zimmerman; Michael Wilschanski; Steven Werlin; David M Troendle; Uzma Shah; Sarah J Schwarzenberg; John F Pohl; Emily Perito; Chee Yee Ooi; Jaimie D Nathan; Veronique D Morinville; Brian A McFerron; Maria R Mascarenhas; Asim Maqbool; Quin Liu; Tom K Lin; Sohail Z Husain; Ryan Himes; Melvin B Heyman; Tanja Gonska; Matthew J Giefer; Cheryl E Gariepy; Steven D Freedman; Douglas S Fishman; Bradley Barth; Maisam Abu-El-Haija; Aliye Uc Journal: J Pediatr Gastroenterol Nutr Date: 2019-11 Impact factor: 2.839