Diabetes-related mortality in adults with cystic fibrosis. Role of genotype and sex

C Lewis, SM Blackman, A Nelson… - American journal of …, 2015 - atsjournals.org
C Lewis, SM Blackman, A Nelson, E Oberdorfer, D Wells, J Dunitz, W Thomas, A Moran
American journal of respiratory and critical care medicine, 2015atsjournals.org
Rationale: Diabetes is associated with increased mortality in cystic fibrosis. Aggressive
screening and early institution of insulin treatment significantly reduced this risk over the
period of 1992–2008. Objectives: To determine if progressive improvement in cystic fibrosis–
related diabetes (CFRD) mortality has continued since 2008, and examine associations with
CFTR genotypes linked to pancreatic insufficiency and to sex. Methods: Chart review was
performed on 664 patients followed from 2008 to 2012. Measurements and Main Results …
Rationale: Diabetes is associated with increased mortality in cystic fibrosis. Aggressive screening and early institution of insulin treatment significantly reduced this risk over the period of 1992–2008.
Objectives: To determine if progressive improvement in cystic fibrosis–related diabetes (CFRD) mortality has continued since 2008, and examine associations with CFTR genotypes linked to pancreatic insufficiency and to sex.
Methods: Chart review was performed on 664 patients followed from 2008 to 2012.
Measurements and Main Results: Overall mortality for patients with CFRD was 1.8 per 100 person-years, compared with 0.5 in patients with CF without diabetes (P = 0.0002); neither rate changed significantly from mortality reported for 2003–2008. Genotype impacted both mortality and diabetes risk: adults with severe CFTR genotypes experienced greater mortality at every age older than 32 years than those with mild genotypes (P = 0.002), and the risk of developing CFRD was also greatly increased in those with severe genotypes (prevalence 60% in adult patients with severe vs. 14% in adults with mild mutations). CFRD had a direct influence on mortality because it was associated with increased risk of death within each genotype category (20 vs. 2%, P = 0.007 for mild; 12 vs. 4%, P = 0.012 for severe). There was also a sex difference in adults with severe CFTR genotypes; both mortality and CFRD prevalence were higher at every age in females than males.
Conclusions: Despite substantial improvement over time, mortality for CFRD patients greater than 30 years remains higher than for patients with CF without diabetes.
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