Associations between glucose tolerance, insulin secretion, muscle and fat mass in cystic fibrosis

Bibi Uhre Nielsen; Daniel Faurholt-Jepsen; Peter Sandor Oturai; Tavs Qvist; Rikke Krogh-Madsen; Terese Lea Katzenstein; James Shaw; Christian Ritz; Tacjana Pressler; Thomas Peter Almdal; Inger Hee Mabuza Mathiesen

doi:10.1177/11795514211038259

Associations between glucose tolerance, insulin secretion, muscle and fat mass in cystic fibrosis

Bibi Uhre Nielsen^*, Daniel Faurholt-Jepsen, Peter Sandor Oturai, Tavs Qvist, Rikke Krogh-Madsen, Terese Lea Katzenstein, James Shaw, Christian Ritz, Tacjana Pressler, Thomas Peter Almdal, Inger Hee Mabuza Mathiesen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

7 Citations (Scopus)

44 Downloads (Pure)

Abstract

Background: A frequent comorbidity in cystic fibrosis (CF) is CF related diabetes (CFRD) caused by a gradual decline in insulin secretion. The reduction in the anabolic hormone, insulin, might explain the weight loss that precedes onset of CFRD. We investigated the association between muscle and fat mass in relation to glucose tolerance and insulin function.

Methods: In a cross-sectional study with CF patients (⩾18 years), we conducted an oral glucose tolerance test and dual energy X-ray absorptiometry scan (DXA). Based on plasma glucose, glucose tolerance was defined as normal (NGT): 1-hour <11.1 mmol/L and 2-hour <7.8 mmol/L, impaired (IGT): 2-hour ⩾7.8 and <11.1 mmol/L or CFRD: 2-hour ⩾11.1 mmol/L. Insulin resistance (HOMA-IR) was derived from fasting levels of plasma glucose and plasma insulin, and fat-free and fat mass index (kg/m²) from DXA. Associations were evaluated using linear regression models adjusted for age, sex, and pancreas insufficiency.

Results: Among 79 CF patients with exocrine pancreas insufficiency, impairment of glucose tolerance corresponded to reduced insulin secretion. In the IGT group the fat-free mass index (FFMI) was 1.2 kg/m² (95% CI: [-2.3, -0.03] kg/m², P = .044) lower compared to the NGT group. FFMI increased insignificantly by 0.4 kg/m² (95% CI: [-0.6, 1.5] kg/m², P = .422) among the insulin-treated CFRD group compared to IGT. Fat mass index (FMI) was not different between groups but tended to decrease with glucose tolerance impairment. For each 100 pmol/L increase in fasting insulin FFMI increased by 1.77 kg/m² (95% CI: [0.21, 3.33] kg/m²/pmol/L/100) and FMI increased by 6.15 kg/m² (95% CI: [3.87, 8.44] kg/m²/pmol/L/100). In multivariate analyses, HOMA-IR was positively associated with FFMI (β = 0.5 kg/m²/HOMA-IR, 95% CI: [0.08, 0.92] kg/m²/HOMA-IR, P = .021) and FMI (β = 1.5 kg/m²/HOMA-IR, 95% CI: [0.87, 2.15] kg/m²/HOMA-IR, P < .001).

Conclusions: Muscle mass was significantly lower among participants with impaired glucose tolerance (IGT), while muscle mass was normalized among those treated with insulin.

Original language	English
Journal	Clinical Medicine Insights: Endocrinology and Diabetes
Volume	14
Pages (from-to)	1-7
Number of pages	7
ISSN	1179-5514
DOIs	https://doi.org/10.1177/11795514211038259
Publication status	Published - 2021

Bibliographical note

Keywords

Faculty of Science
Cystic fibrosis
Fat-free mass
Fat mass
Diabetes
Insulin secretion deficiency

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10.1177/11795514211038259Licence: CC BY-NC

Nielsen et al_Clinical Medicine Insights - Endocrinology and Diabetes_2021_Vol 14_1-7Final published version, 390 KBLicence: CC BY-NC

Cite this

Nielsen, B. U., Faurholt-Jepsen, D., Oturai, P. S., Qvist, T., Krogh-Madsen, R., Katzenstein, T. L., Shaw, J., Ritz, C., Pressler, T., Almdal, T. P., & Mathiesen, I. H. M. (2021). Associations between glucose tolerance, insulin secretion, muscle and fat mass in cystic fibrosis. Clinical Medicine Insights: Endocrinology and Diabetes, 14, 1-7. https://doi.org/10.1177/11795514211038259

Nielsen, BU, Faurholt-Jepsen, D, Oturai, PS, Qvist, T, Krogh-Madsen, R, Katzenstein, TL, Shaw, J, Ritz, C, Pressler, T, Almdal, TP & Mathiesen, IHM 2021, 'Associations between glucose tolerance, insulin secretion, muscle and fat mass in cystic fibrosis', Clinical Medicine Insights: Endocrinology and Diabetes, vol. 14, pp. 1-7. https://doi.org/10.1177/11795514211038259

@article{910964b359e942feab92a3b43b9bf460,

title = "Associations between glucose tolerance, insulin secretion, muscle and fat mass in cystic fibrosis",

abstract = "Background: A frequent comorbidity in cystic fibrosis (CF) is CF related diabetes (CFRD) caused by a gradual decline in insulin secretion. The reduction in the anabolic hormone, insulin, might explain the weight loss that precedes onset of CFRD. We investigated the association between muscle and fat mass in relation to glucose tolerance and insulin function.Methods: In a cross-sectional study with CF patients (⩾18 years), we conducted an oral glucose tolerance test and dual energy X-ray absorptiometry scan (DXA). Based on plasma glucose, glucose tolerance was defined as normal (NGT): 1-hour <11.1 mmol/L and 2-hour <7.8 mmol/L, impaired (IGT): 2-hour ⩾7.8 and <11.1 mmol/L or CFRD: 2-hour ⩾11.1 mmol/L. Insulin resistance (HOMA-IR) was derived from fasting levels of plasma glucose and plasma insulin, and fat-free and fat mass index (kg/m2) from DXA. Associations were evaluated using linear regression models adjusted for age, sex, and pancreas insufficiency.Results: Among 79 CF patients with exocrine pancreas insufficiency, impairment of glucose tolerance corresponded to reduced insulin secretion. In the IGT group the fat-free mass index (FFMI) was 1.2 kg/m2 (95% CI: [-2.3, -0.03] kg/m2, P = .044) lower compared to the NGT group. FFMI increased insignificantly by 0.4 kg/m2 (95% CI: [-0.6, 1.5] kg/m2, P = .422) among the insulin-treated CFRD group compared to IGT. Fat mass index (FMI) was not different between groups but tended to decrease with glucose tolerance impairment. For each 100 pmol/L increase in fasting insulin FFMI increased by 1.77 kg/m2 (95% CI: [0.21, 3.33] kg/m2/pmol/L/100) and FMI increased by 6.15 kg/m2 (95% CI: [3.87, 8.44] kg/m2/pmol/L/100). In multivariate analyses, HOMA-IR was positively associated with FFMI (β = 0.5 kg/m2/HOMA-IR, 95% CI: [0.08, 0.92] kg/m2/HOMA-IR, P = .021) and FMI (β = 1.5 kg/m2/HOMA-IR, 95% CI: [0.87, 2.15] kg/m2/HOMA-IR, P < .001).Conclusions: Muscle mass was significantly lower among participants with impaired glucose tolerance (IGT), while muscle mass was normalized among those treated with insulin.",

keywords = "Faculty of Science, Cystic fibrosis, Fat-free mass, Fat mass, Diabetes, Insulin secretion deficiency",

author = "Nielsen, {Bibi Uhre} and Daniel Faurholt-Jepsen and Oturai, {Peter Sandor} and Tavs Qvist and Rikke Krogh-Madsen and Katzenstein, {Terese Lea} and James Shaw and Christian Ritz and Tacjana Pressler and Almdal, {Thomas Peter} and Mathiesen, {Inger Hee Mabuza}",

note = "{\textcopyright} The Author(s) 2021.",

year = "2021",

doi = "10.1177/11795514211038259",

language = "English",

volume = "14",

pages = "1--7",

journal = "Clinical Medicine Insights: Endocrinology and Diabetes",

issn = "1179-5514",

publisher = "Libertas Academica Ltd.",

}

TY - JOUR

T1 - Associations between glucose tolerance, insulin secretion, muscle and fat mass in cystic fibrosis

AU - Nielsen, Bibi Uhre

AU - Faurholt-Jepsen, Daniel

AU - Oturai, Peter Sandor

AU - Qvist, Tavs

AU - Krogh-Madsen, Rikke

AU - Katzenstein, Terese Lea

AU - Shaw, James

AU - Ritz, Christian

AU - Pressler, Tacjana

AU - Almdal, Thomas Peter

AU - Mathiesen, Inger Hee Mabuza

PY - 2021

Y1 - 2021

N2 - Background: A frequent comorbidity in cystic fibrosis (CF) is CF related diabetes (CFRD) caused by a gradual decline in insulin secretion. The reduction in the anabolic hormone, insulin, might explain the weight loss that precedes onset of CFRD. We investigated the association between muscle and fat mass in relation to glucose tolerance and insulin function.Methods: In a cross-sectional study with CF patients (⩾18 years), we conducted an oral glucose tolerance test and dual energy X-ray absorptiometry scan (DXA). Based on plasma glucose, glucose tolerance was defined as normal (NGT): 1-hour <11.1 mmol/L and 2-hour <7.8 mmol/L, impaired (IGT): 2-hour ⩾7.8 and <11.1 mmol/L or CFRD: 2-hour ⩾11.1 mmol/L. Insulin resistance (HOMA-IR) was derived from fasting levels of plasma glucose and plasma insulin, and fat-free and fat mass index (kg/m2) from DXA. Associations were evaluated using linear regression models adjusted for age, sex, and pancreas insufficiency.Results: Among 79 CF patients with exocrine pancreas insufficiency, impairment of glucose tolerance corresponded to reduced insulin secretion. In the IGT group the fat-free mass index (FFMI) was 1.2 kg/m2 (95% CI: [-2.3, -0.03] kg/m2, P = .044) lower compared to the NGT group. FFMI increased insignificantly by 0.4 kg/m2 (95% CI: [-0.6, 1.5] kg/m2, P = .422) among the insulin-treated CFRD group compared to IGT. Fat mass index (FMI) was not different between groups but tended to decrease with glucose tolerance impairment. For each 100 pmol/L increase in fasting insulin FFMI increased by 1.77 kg/m2 (95% CI: [0.21, 3.33] kg/m2/pmol/L/100) and FMI increased by 6.15 kg/m2 (95% CI: [3.87, 8.44] kg/m2/pmol/L/100). In multivariate analyses, HOMA-IR was positively associated with FFMI (β = 0.5 kg/m2/HOMA-IR, 95% CI: [0.08, 0.92] kg/m2/HOMA-IR, P = .021) and FMI (β = 1.5 kg/m2/HOMA-IR, 95% CI: [0.87, 2.15] kg/m2/HOMA-IR, P < .001).Conclusions: Muscle mass was significantly lower among participants with impaired glucose tolerance (IGT), while muscle mass was normalized among those treated with insulin.

AB - Background: A frequent comorbidity in cystic fibrosis (CF) is CF related diabetes (CFRD) caused by a gradual decline in insulin secretion. The reduction in the anabolic hormone, insulin, might explain the weight loss that precedes onset of CFRD. We investigated the association between muscle and fat mass in relation to glucose tolerance and insulin function.Methods: In a cross-sectional study with CF patients (⩾18 years), we conducted an oral glucose tolerance test and dual energy X-ray absorptiometry scan (DXA). Based on plasma glucose, glucose tolerance was defined as normal (NGT): 1-hour <11.1 mmol/L and 2-hour <7.8 mmol/L, impaired (IGT): 2-hour ⩾7.8 and <11.1 mmol/L or CFRD: 2-hour ⩾11.1 mmol/L. Insulin resistance (HOMA-IR) was derived from fasting levels of plasma glucose and plasma insulin, and fat-free and fat mass index (kg/m2) from DXA. Associations were evaluated using linear regression models adjusted for age, sex, and pancreas insufficiency.Results: Among 79 CF patients with exocrine pancreas insufficiency, impairment of glucose tolerance corresponded to reduced insulin secretion. In the IGT group the fat-free mass index (FFMI) was 1.2 kg/m2 (95% CI: [-2.3, -0.03] kg/m2, P = .044) lower compared to the NGT group. FFMI increased insignificantly by 0.4 kg/m2 (95% CI: [-0.6, 1.5] kg/m2, P = .422) among the insulin-treated CFRD group compared to IGT. Fat mass index (FMI) was not different between groups but tended to decrease with glucose tolerance impairment. For each 100 pmol/L increase in fasting insulin FFMI increased by 1.77 kg/m2 (95% CI: [0.21, 3.33] kg/m2/pmol/L/100) and FMI increased by 6.15 kg/m2 (95% CI: [3.87, 8.44] kg/m2/pmol/L/100). In multivariate analyses, HOMA-IR was positively associated with FFMI (β = 0.5 kg/m2/HOMA-IR, 95% CI: [0.08, 0.92] kg/m2/HOMA-IR, P = .021) and FMI (β = 1.5 kg/m2/HOMA-IR, 95% CI: [0.87, 2.15] kg/m2/HOMA-IR, P < .001).Conclusions: Muscle mass was significantly lower among participants with impaired glucose tolerance (IGT), while muscle mass was normalized among those treated with insulin.

KW - Faculty of Science

KW - Cystic fibrosis

KW - Fat-free mass

KW - Fat mass

KW - Diabetes

KW - Insulin secretion deficiency

U2 - 10.1177/11795514211038259

DO - 10.1177/11795514211038259

M3 - Journal article

C2 - 34413690

SN - 1179-5514

VL - 14

SP - 1

EP - 7

JO - Clinical Medicine Insights: Endocrinology and Diabetes

JF - Clinical Medicine Insights: Endocrinology and Diabetes

ER -