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Screening for Cystic Fibrosis-Related Diabetes: Matching Pathophysiology and Addressing Current Challenges

      Abstract

      Nearly 50% of adult patients with cystic fibrosis (CF) have diabetes. The occurrence of CF-related diabetes (CFRD) is preceded and is associated with deterioration of lung function and nutritional status. Microvascular complications can occur, but the main cause of death is respiratory failure rather than cardiovascular causes as in type 1 or type 2 diabetes. Because other methods such as glycated hemoglobin (A1C) levels are less sensitive in patients with CF, the recommended screening test is the oral glucose tolerance test (OGTT) with a 75 g glucose dose. However, OGTT is poorly suited for patients with CF, who are already facing a high disease-care burden, and appropriate CF-glucose cut-off for diagnosis and prognosis are also questioned. Thus, alternative screening methods are compared to the classical test (2-hour OGTT), including shorter OGTTs and continuous glucose monitoring. Moreover, many challenges complicate the screening for diabetes such as the complex medical care time for a patient, which is reflected by low adherence to screening tests. The best screening test should take into account the particularities of CFRD and the complexity of the CF medical care.

      Résumé

      Presque 50 % des patients adultes atteints de fibrose kystique (FK) ont le diabète. La survenue du diabète associé à la fibrose kystique (DAFK) est précédée et associée à la détérioration du fonctionnement des poumons et de l'état nutritionnel. Des complications microvasculaires peuvent survenir, mais la cause principale de décès est l'insuffisance respiratoire plutôt que les causes cardiovasculaires comme dans le diabète de type 1 ou de type 2. Puisque les autres méthodes telles que les concentrations d'hémoglobine glyquée (A1c) montrent une moins bonne sensibilité chez les patients atteints de FK, le test de dépistage recommandé est l'épreuve d'hyperglycémie provoquée par voie orale (HGPO) utilisant 75 g de glucose. Cependant, l'HGPO convient mal aux patients atteints de FK, qui font déjà face à un fardeau élevé en matière de soins liés à la maladie, et les valeurs limites de la glycémie appropriées au diagnostic et au pronostic en présence de FK sont également remises en question. Par conséquent, les autres méthodes de dépistage sont comparées à l'épreuve traditionnelle (HGPO de 2 heures), y compris les HGPO plus courtes et la surveillance de la glycémie en continu. De plus, plusieurs problèmes tels que le temps de soins médicaux complexes d'un patient, qui se traduit par un faible respect des tests de dépistage, compliquent le dépistage du diabète. Le meilleur test de dépistage devrait tenir compte des particularités du DAFK et de la complexité des soins médicaux liés à la FK.

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      Mots clés

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