Poor Glucose Control Associated With Worse FEV1 Recovery Rates in CFRD

This article is part of MPR‘s coverage of the American Thoracic Society International Conference, taking place in Dallas, Texas. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2019.

DALLAS – Patients with cystic fibrosis-related diabetes (CFRD) who experience acute pulmonary exacerbation, and who report poor glucose control, may recover faster from completing antibiotic treatment in the hospital rather than at home. This research was presented at the American Thoracic Society International Conference, held May 17-22, 2019, in Dallas, Texas.

The investigators of this study sought to assess whether short-term glucose control affects forced expiratory volume (FEV1) recovery during acute pulmonary exacerbation in patients with CFRD. The study included patients aged 6 to 21 years who were hospitalized for pulmonary exacerbations at the Children’s Hospital of Pittsburgh Pediatric Cystic Fibrosis Center from 2010 to 2016. Electronic health records were analyzed for 164 hospitalizations, including 67 CFRD cases, abstracting data on FEV1 during pulmonary exacerbation episodes, clinical covariates, and glucose control measures using area under the meter blood glucose curve (AUC) and hemoglobin A1c. FEV1 recovery was the primary outcome, which was reported at discharge, end of treatment, and follow-up.

Patients with CFRD who completed IV antibiotics at home were treated for a longer duration than those who completed treatment in the hospital (22.2 vs 13.8 days; P <.001). For patients receiving treatment at home, poor glucose control was associated with worse FEV1 recovery. Recovery was 25% lower for each log-unit higher AUC at discharge (95% CI, -0.5% to -50%), and 45% lower in the first 48 hours at home (95% CI, -5.7% to -83.9%). Similar results were reported for the end of treatment and the next follow-up visit. For each unit increase in AUC/day, the associated recovery rate was 0.4% lower (95% CI, -0.1% to -0.8%). For each mg/dL increase in median glucose level, the recovery rate was 0.3% lower (95% CI, -0.01% to -0.3%). Glucose control in patients with CFRD who completed in-hospital treatment was not significantly associated with FEV1 recovery, although small but significant increases across outcome measures were reported.

Higher blood glucose AUC in the first 48 hours, AUC/day, and median glucose levels were associated with slower FEV1 recovery in patients with CFRD who completed antibiotic treatment at home. The investigators suggest that patients with CFRD and poor glucose control will benefit most from completing treatment in the hospital.

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Reference

Okoniewski W, Hughan K, Weiner G, Weiner DJ, Forno E. Glucose control and lung function recovery during acute pulmonary exacerbation in patients with cystic fibrosis-related diabetes. Poster presented at: American Thoracic Society International Conference; May 17-22, 2019; Dallas, TX. Abstract A1910/P609.

This article originally appeared on Pulmonology Advisor