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Categories of abnormal glucose tolerance in cystic fibrosis

Categories of abnormal glucose tolerance in cystic fibrosis
Category Fasting plasma glucose before test Plasma glucose 2 hours after ingestion of 1.75 g/kg glucose Clinical outcomes
Normal glucose tolerance (NGT)*

<126 mg/dL

(7 mmol/L)

<140 mg/dL

(7.8 mmol/L)

 In general, clinically stable
Prediabetes categories
Indeterminate glycemia (INDET)

<126 mg/dL

(7 mmol/L)

 <140 mg/dL (7.8 mmol/L), with a mid-point peak >200 mg/dL (11.1 mmol/L) Clinical impact unclear but evidence suggests increased risk of morbidity
Impaired glucose tolerance (IGT)

<126 mg/dL

(7 mmol/L)

140 to 200 mg/dL

(7.8 to 11.1 mmol/L)
CFRD
CFRD without fasting hyperglycemia

<126 mg/dL

(7 mmol/L)

≥200 mg/dL

(11.1 mmol/L)

 Increased morbidity and mortality
CFRD with fasting hyperglycemia

≥126 mg/dL

(7 mmol/L)

 OGTT not necessary

CFRD: cystic fibrosis-related diabetes; OGTT: oral glucose tolerance test.

* In the past, fasting plasma glucose 100 to <126 mg/dL (5.6 to 7 mmol/L) has been termed impaired fasting glucose. However, because the clinical significance of impaired fasting glucose in people with cystic fibrosis is unclear, it is not generally used as a diagnostic category in the CFRD spectrum.

¶ Historically, CFRD was subcategorized by the absence or presence of fasting hyperglycemia (fasting plasma glucose ≥126 mg/dL [7.0 mmol/L]). Fasting hyperglycemia usually represents a more advanced stage of disease and is associated with microvascular complications[1]. However, because treatment may be beneficial for patients with and without fasting hyperglycemia, this distinction is no longer made[2].

References:
  1. Moran A, Brunzell C, Cohen RC, et al. Clinical care guidelines for cystic fibrosis-related diabetes: A position statement of the American Diabetes Association and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society. Diabetes Care 2010; 33:2697.
  2. Ode KL, Ballman M, Battezzati A, et al. ISPAD clinical practice consensus guidelines 2022: Management of cystic fibrosis-related diabetes in children and adolescents. Pediatr Diabetes 2022; 23:1212.

Adapted from: Moran A, Hardin D, Rodman D, Allen HF, Beall RJ, Borowitz D, et al. Diagnosis, screening and management of cystic fibrosis related diabetes mellitus: a consensus conference report. Diabetes Research Clin Practice 1999; 45:61.

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