Microvascular Complications in Cystic Fibrosis–Related Diabetes

  1. Sarah Jane Schwarzenberg, MD1,
  2. William Thomas, PHD2,
  3. Timothy W. Olsen, MD3,
  4. Trish Grover, RN1,
  5. David Walk, MD4,
  6. Carlos Milla, MD1 and
  7. Antoinette Moran, MD1
  1. 1Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
  2. 2Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota
  3. 3Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota
  4. 4Department of Neurology, University of Minnesota, Minneapolis, Minnesota
  1. Address correspondence and reprint requests to Antoinette Moran, MD, Pediatric Endocrinology MMC 404, University of Minnesota, 516 Delaware St., SE, Minneapolis, MN 55454. E-mail: moran001{at}umn.edu

Abstract

OBJECTIVE—The incidence of cystic fibrosis–related diabetes (CFRD) and the prevalence of diabetic microvascular complications were determined at the University of Minnesota.

RESEARCH DESIGN AND METHODS—Cystic fibrosis patients have undergone annual oral glucose tolerance testing since 1990. Database review was performed to determine diabetes duration and the results of annual urine albumin-to-creatinine ratio (Ualb:Cr) screening and dilated retinal exams. In addition, 59 individuals underwent detailed retinopathy, nephropathy, neuropathy, and gastroenterpathy screening.

RESULTS—During 1990–2005, 775 patients aged ≥6 years were followed. CFRD was diagnosed by an oral glucose tolerance test or fasting hyperglycemia in 285 subjects (52% female), 64% of whom had fasting hyperglycemia. Most patients with CFRD without fasting hyperglycemia progressed to CFRD with fasting hyperglycemia over time. No subject with CFRD without fasting hyperglycemia had retinopathy or abnormal Ualb:Cr. In CFRD subjects with fasting hyperglycemia and diabetes for ≥10 years, 14% had microalbuminuria and 16% had retinopathy. Autonomic neuropathy and gastrointestinal symptoms each were seen in 52% and somatic abnormalities in 22% of patients with or without fasting hyperglycemia.

CONCLUSIONS—Diabetic microvascular complications occur in CFRD, although the prevalence of retinopathy and nephropathy appears to be less than that found in other forms of diabetes. Annual complication screening should occur after known diabetes duration of 5 years in patients with CFRD with fasting hyperglycemia.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 23 February 2007. DOI: 10.2337/dc06-1576.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted February 3, 2007.
    • Received July 26, 2006.
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  1. Published online before print February 23, 2007, doi: 10.2337/dc06-1576 Diabetes Care May 2007 vol. 30 no. 5 1056-1061
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