Sputum Glucose and Glycemic Control in Cystic Fibrosis-Related Diabetes: A Cross-Sectional Study
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{"title"=>"Sputum glucose and glycemic control in cystic fibrosis-related diabetes: A cross-sectional study", "type"=>"journal", "authors"=>[{"first_name"=>"Lindsey", "last_name"=>"Van Sambeek", "scopus_author_id"=>"56575021300"}, {"first_name"=>"Elise S.", "last_name"=>"Cowley", "scopus_author_id"=>"56397862400"}, {"first_name"=>"Dianne K.", "last_name"=>"Newman", "scopus_author_id"=>"7402964625"}, {"first_name"=>"Roberta", "last_name"=>"Kato", "scopus_author_id"=>"36813623700"}], "year"=>2015, "source"=>"PLoS ONE", "identifiers"=>{"pui"=>"603281472", "issn"=>"19326203", "doi"=>"10.1371/journal.pone.0119938", "scopus"=>"2-s2.0-84925873039", "pmid"=>"25803537", "sgr"=>"84925873039"}, "id"=>"fc6a29cf-8a5d-3898-a635-dfd0e5b22737", "abstract"=>"Cystic fibrosis-related diabetes affects up to half of cystic fibrosis patients and is associated with increased mortality and more frequent pulmonary exacerbations. However, it is unclear to what degree good glycemic control might mitigate these risks and clinical outcomes have not previously been studied in relation to glucose from the lower airways, the site of infection and CF disease progression. We initially hypothesized that diabetic cystic fibrosis patients with glycosylated hemoglobin (HbA(1c)) > 6.5% have worse pulmonary function, longer and more frequent exacerbations and also higher sputum glucose levels than patients with HbA(1c) </= 6.5% or cystic fibrosis patients without diabetes. To test this, we analyzed spontaneously expectorated sputum samples from 88 cystic fibrosis patients. The median sputum glucose concentration was 0.70 mM (mean, 4.75 mM; range, 0-64.6 mM). Sputum glucose was not correlated with age, sex, body mass index, diabetes diagnosis, glycemic control, exacerbation frequency or length, or pulmonary function. Surprisingly, sputum glucose was highest in subjects with normal glucose tolerance, suggesting the dynamics of glycemic control, sputum glucose and pulmonary infections are more complex than previously thought. Two-year mean HbA(1c) was positively correlated with the length of exacerbation admission (p < 0.01), and negatively correlated with measures of pulmonary function (p < 0.01). While total number of hospitalizations for exacerbations were not significantly different, subjects with an HbA(1c) > 6.5% were hospitalized on average 6 days longer than those with HbA(1c) </= 6.5% (p < 0.01). Current clinical care guidelines for cystic fibrosis-related diabetes target HbA(1c) </= 7% to limit long-term microvascular damage, but more stringent glycemic control (HbA(1c) </= 6.5%) may further reduce the short-term pulmonary complications.", "link"=>"http://www.mendeley.com/research/sputum-glucose-glycemic-control-cystic-fibrosisrelated-diabetes-crosssectional-study", "reader_count"=>18, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>2, "Librarian"=>1, "Student > Doctoral Student"=>1, "Researcher"=>1, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>1, "Other"=>4, "Student > Master"=>1, "Student > Bachelor"=>1, "Lecturer"=>1, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>2, "Librarian"=>1, "Student > Doctoral Student"=>1, "Researcher"=>1, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>1, "Other"=>4, "Student > Master"=>1, "Student > Bachelor"=>1, "Lecturer"=>1, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Engineering"=>1, "Nursing and Health Professions"=>1, "Agricultural and Biological Sciences"=>4, "Medicine and Dentistry"=>6, "Social Sciences"=>1, "Immunology and Microbiology"=>2}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>6}, "Social Sciences"=>{"Social Sciences"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Unspecified"=>{"Unspecified"=>3}}, "group_count"=>2}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1986051"], "description"=>"<p>CFRD subjects had significantly higher HbA<sub>1c</sub> than subjects with impaired (IGT) or normal glucose tolerance (NGT, left panel), while NGT subjects had significantly higher average sputum glucose than IGT or CFRD subjects (right panel). Diamonds are centered on each category’s mean and the vertical distance represents the 95% confidence interval.</p>", "links"=>[], "tags"=>["sputum glucose concentration", "CF disease progression", "lt", "fibrosis patients", "body mass index", "exacerbation", "glycemic control", "expectorated sputum samples", "function", "sputum glucose", "mm", "HbA 1c", "sputum glucose levels", "diabetes"], "article_id"=>1353758, "categories"=>["Biological Sciences"], "users"=>["Lindsey Van Sambeek", "Elise S. Cowley", "Dianne K. Newman", "Roberta Kato"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0119938.g002", "stats"=>{"downloads"=>3, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparisons_of_HbA_1c_and_SG_by_glucose_tolerance_/1353758", "title"=>"Comparisons of HbA<sub>1c</sub> and SG by glucose tolerance.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-24 05:06:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1986056"], "description"=>"<p>R<sup>2</sup> and p-values from correlations between SG and clinical parameters.</p>", "links"=>[], "tags"=>["sputum glucose concentration", "CF disease progression", "lt", "fibrosis patients", "body mass index", "exacerbation", "glycemic control", "expectorated sputum samples", "function", "sputum glucose", "mm", "HbA 1c", "sputum glucose levels", "diabetes"], "article_id"=>1353763, "categories"=>["Biological Sciences"], "users"=>["Lindsey Van Sambeek", "Elise S. Cowley", "Dianne K. Newman", "Roberta Kato"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0119938.t002", "stats"=>{"downloads"=>2, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_R_2_and_p_values_from_correlations_between_SG_and_clinical_parameters_/1353763", "title"=>"R<sup>2</sup> and p-values from correlations between SG and clinical parameters.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-03-24 05:06:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1986055"], "description"=>"<p>Study participant demographic information, n = 88.</p>", "links"=>[], "tags"=>["sputum glucose concentration", "CF disease progression", "lt", "fibrosis patients", "body mass index", "exacerbation", "glycemic control", "expectorated sputum samples", "function", "sputum glucose", "mm", "HbA 1c", "sputum glucose levels", "diabetes"], "article_id"=>1353762, "categories"=>["Biological Sciences"], "users"=>["Lindsey Van Sambeek", "Elise S. Cowley", "Dianne K. Newman", "Roberta Kato"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0119938.t001", "stats"=>{"downloads"=>1, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_participant_demographic_information_n_88_/1353762", "title"=>"Study participant demographic information, n = 88.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-03-24 05:06:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1986050"], "description"=>"<p>Sputum glucose (SG) was much lower than previously reported, with 34% reading < 0.01 mM, and 55% of samples reading < 1.0 mM. The distribution of SG was highly skewed: the median concentration was 0.7 mM (IQR, 0–3.5 mM) versus the mean of 4.75 mM (SD 11.4 mM).</p>", "links"=>[], "tags"=>["sputum glucose concentration", "CF disease progression", "lt", "fibrosis patients", "body mass index", "exacerbation", "glycemic control", "expectorated sputum samples", "function", "sputum glucose", "mm", "HbA 1c", "sputum glucose levels", "diabetes"], "article_id"=>1353757, "categories"=>["Biological Sciences"], "users"=>["Lindsey Van Sambeek", "Elise S. Cowley", "Dianne K. Newman", "Roberta Kato"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0119938.g001", "stats"=>{"downloads"=>2, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Distribution_of_sputum_glucose_concentration_in_117_samples_/1353757", "title"=>"Distribution of sputum glucose concentration in 117 samples.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-24 05:06:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1986058", "https://ndownloader.figshare.com/files/1986059"], "description"=>"<div><p>Cystic fibrosis-related diabetes affects up to half of cystic fibrosis patients and is associated with increased mortality and more frequent pulmonary exacerbations. However, it is unclear to what degree good glycemic control might mitigate these risks and clinical outcomes have not previously been studied in relation to glucose from the lower airways, the site of infection and CF disease progression. We initially hypothesized that diabetic cystic fibrosis patients with glycosylated hemoglobin (HbA<sub>1c</sub>) > 6.5% have worse pulmonary function, longer and more frequent exacerbations and also higher sputum glucose levels than patients with HbA<sub>1c</sub> ≤ 6.5% or cystic fibrosis patients without diabetes. To test this, we analyzed spontaneously expectorated sputum samples from 88 cystic fibrosis patients. The median sputum glucose concentration was 0.70 mM (mean, 4.75 mM; range, 0-64.6 mM). Sputum glucose was not correlated with age, sex, body mass index, diabetes diagnosis, glycemic control, exacerbation frequency or length, or pulmonary function. Surprisingly, sputum glucose was highest in subjects with normal glucose tolerance, suggesting the dynamics of glycemic control, sputum glucose and pulmonary infections are more complex than previously thought. Two-year mean HbA<sub>1c</sub> was positively correlated with the length of exacerbation admission (p < 0.01), and negatively correlated with measures of pulmonary function (p < 0.01). While total number of hospitalizations for exacerbations were not significantly different, subjects with an HbA<sub>1c</sub> > 6.5% were hospitalized on average 6 days longer than those with HbA<sub>1c</sub> ≤ 6.5% (p < 0.01). Current clinical care guidelines for cystic fibrosis-related diabetes target HbA<sub>1c</sub> ≤ 7% to limit long-term microvascular damage, but more stringent glycemic control (HbA<sub>1c</sub> ≤ 6.5%) may further reduce the short-term pulmonary complications.</p></div>", "links"=>[], "tags"=>["sputum glucose concentration", "CF disease progression", "lt", "fibrosis patients", "body mass index", "exacerbation", "glycemic control", "expectorated sputum samples", "function", "sputum glucose", "mm", "HbA 1c", "sputum glucose levels", "diabetes"], "article_id"=>1353765, "categories"=>["Biological Sciences"], "users"=>["Lindsey Van Sambeek", "Elise S. Cowley", "Dianne K. Newman", "Roberta Kato"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0119938.s001", "https://dx.doi.org/10.1371/journal.pone.0119938.s002"], "stats"=>{"downloads"=>2, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Sputum_Glucose_and_Glycemic_Control_in_Cystic_Fibrosis_Related_Diabetes_A_Cross_Sectional_Study_/1353765", "title"=>"Sputum Glucose and Glycemic Control in Cystic Fibrosis-Related Diabetes: A Cross-Sectional Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2015-03-24 05:06:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1986057"], "description"=>"<p>Clinical parameters of CFRD subjects.</p>", "links"=>[], "tags"=>["sputum glucose concentration", "CF disease progression", "lt", "fibrosis patients", "body mass index", "exacerbation", "glycemic control", "expectorated sputum samples", "function", "sputum glucose", "mm", "HbA 1c", "sputum glucose levels", "diabetes"], "article_id"=>1353764, "categories"=>["Biological Sciences"], "users"=>["Lindsey Van Sambeek", "Elise S. Cowley", "Dianne K. Newman", "Roberta Kato"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0119938.t003", "stats"=>{"downloads"=>5, "page_views"=>36, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Clinical_parameters_of_CFRD_subjects_/1353764", "title"=>"Clinical parameters of CFRD subjects.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-03-24 05:06:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1986054"], "description"=>"<p>CFRD subjects with HbA<sub>1c</sub> > 6.5% had significantly reduced average scores of forced expiratory volume in one second (FEV<sub>1</sub>, left panel) and forced expiratory flow in the 25–75% of the patient’s exhaled volume (FEF25–75%, right panel) compared to CFRD subjects with HbA<sub>1c</sub> ≤ 6.5%. Diamonds are centered on each category’s mean and the vertical distance represents the 95% confidence interval.</p>", "links"=>[], "tags"=>["sputum glucose concentration", "CF disease progression", "lt", "fibrosis patients", "body mass index", "exacerbation", "glycemic control", "expectorated sputum samples", "function", "sputum glucose", "mm", "HbA 1c", "sputum glucose levels", "diabetes"], "article_id"=>1353761, "categories"=>["Biological Sciences"], "users"=>["Lindsey Van Sambeek", "Elise S. Cowley", "Dianne K. Newman", "Roberta Kato"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0119938.g004", "stats"=>{"downloads"=>1, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mean_pulmonary_function_test_results_by_glycemic_control_in_CFRD_/1353761", "title"=>"Mean pulmonary function test results by glycemic control in CFRD.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-24 05:06:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1986052"], "description"=>"<p>CFRD subjects had approximately twice as many pulmonary exacerbations as subjects with impaired (IGT) or normal glucose tolerance (NGT, left panel). The average length of admission was not significantly different between these groups (right panel). Diamonds are centered on each category’s mean and the vertical distance represents the 95% confidence interval.</p>", "links"=>[], "tags"=>["sputum glucose concentration", "CF disease progression", "lt", "fibrosis patients", "body mass index", "exacerbation", "glycemic control", "expectorated sputum samples", "function", "sputum glucose", "mm", "HbA 1c", "sputum glucose levels", "diabetes"], "article_id"=>1353759, "categories"=>["Biological Sciences"], "users"=>["Lindsey Van Sambeek", "Elise S. Cowley", "Dianne K. Newman", "Roberta Kato"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0119938.g003", "stats"=>{"downloads"=>0, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Glucose_tolerance_and_two_year_pulmonary_exacerbation_history_/1353759", "title"=>"Glucose tolerance and two-year pulmonary exacerbation history.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-24 05:06:00"}

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Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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