Cystic Fibrosis Related Diabetes: Current Trends in Prevalence, Incidence and Mortality

Abstract

Objective: CFRD diagnosis and management have changed considerably since diabetes was first shown to be associated with a poor prognosis in CF. Current trends in CFRD prevalence, incidence and mortality were determined from a comprehensive clinical database.

Research Design and Methods: Data were reviewed from 872 CF patients followed at the University of Minnesota during three consecutive intervals: 1992-1997, 1998-2002, and 2003-2008.

Results: CFRD is currently present in 2% of children, 19% of adolescents, and 40-50% of adults. Incidence and prevalence are higher in females age 30-39, but otherwise there is no gender difference. In younger individuals, CFRD without fasting hyperglycemia (FH-) predominates, but fasting hyperglycemia (FH+) prevalence rises with age. CFRD mortality has significantly decreased over time. From 1992–1997 to 2003–2008, female mortality dropped by >50% from 6.9 to 3.2 deaths per 100-patient-years, and in males from 6.5 to 3.8 deaths per 100-patient-years. There is no longer a gender difference in mortality. Earlier, diabetes was diagnosed as a peri-morbid event in nearly 20% of patients, but of 61 patients diagnosed with diabetes during 2003–2008, only 2 died. Lung function but not nutritional status is still worse in CF patients with diabetes compared to those without. Nutritional and pulmonary status are similar between FH- and FH+.

Conclusions: Previously noted gender differences in mortality have disappeared, and the gap in mortality between CF patients with and without diabetes has narrowed considerably. We believe that early diagnosis and aggressive treatment have played a major role in improving survival in these patients.