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Cystic Fibrosis-Related Diabetes Associated With Race/Ethnicity - Endocrinology Advisor

Black race and Hispanic ethnicity are associated with higher incidence and prevalence of cystic fibrosis-related diabetes (CFRD), according to study findings published in the Journal of Cystic Fibrosis. Investigators explored whether Black race and Hispanic et

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Black race and Hispanic ethnicity are associated with higher incidence and prevalence of cystic fibrosis-related diabetes (CFRD), according to study findings published in the Journal of Cystic Fibrosis.

Investigators explored whether Black race and Hispanic ethnicity were associated with higher prevalence and incidence of CFRD.

In this retrospective cohort study, investigators used data from the CF Foundation Patient Registry from 2010 to 2019 to determine the prevalence and incidence of CFRD by race/ethnicity. Data were stratified by age at baseline in 2010 into 3 cohorts (11-20 years [y]; 21-30y; 31-40y). Logistic regression was used to determine prevalence and Cox regression was used to determine incidence following adjustments for clinical factors, demographics, socioeconomic status, and chronic medication use. The study did not include persons over 40 years of age due to the fewer number of eligible participants in this age category. Notably, in 2010, median life expectancy for persons with CF was 37 years.

Registry participants (N=14,660) included 510 non-Hispanic Black (NHB) patients and 890 Hispanic patients. Age cohorts were slightly uneven with respect to sex, with progressively fewer women in the older age cohorts (48.0% women in the 11-20y cohort; 46.8% in the 21-30y cohort; and 46.6% in the 31-40y cohort).

In all age cohorts, the investigators found that being a NHB vs a NH White patient was associated with higher odds of CFRD baseline prevalence (11-20y OR, 2.53; 95% CI, 1.88-3.41; 21-30y OR, 1.80; 95% CI, 1.25-2.59; 31-40y OR, 1.93; 95% CI, 1.00-3.73; P <.005 for all). In the youngest age cohort, there was a 40% higher risk for new onset CFRD among NHB patients (hazard ratio [HR], 1.40; 95% CI, 1.09-1.80) and a 19% higher risk among Hispanic patients (HR, 1.19; 95% CI, 1.01-1.41; P <.005 for all).

Compared with NHB men, NHB women had increased odds of having CFRD. Other factors associated with higher odds of CFRD included forced expiratory volume in 1 second percent predicted less than 40, liver disease, and public health insurance. Obesity was associated with CFRD incidence in the youngest cohort.

In citing study limitations, the researchers noted that not all eligible patients underwent screening, so CFRD may have been underdiagnosed. Additionally, income data was mostly missing, as was family history of type 2 diabetes.

The study authors concluded, “NHB had higher CFRD prevalence and NHB and Hispanic youth had higher CFRD incidence that were not mitigated after adjusting for genotype. Additionally, public health insurance and obesity associated with CFRD development.”

This article originally appeared on Pulmonology Advisor

References:

Rayas MS, Mbogo B, Kelly A, Vu P, Magaret A, Daley T. Association of race and ethnicity with the development of cystic fibrosis-related diabetes. J Cyst Fibros. Published online August 3, 2024. doi:10.1016/j.jcf.2024.07.018

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Related questions

01When to see a doctor

If you or your child has symptoms of cystic fibrosis — or if someone in your family has CF — talk with your healthcare professional about testing for the condition. Make an appointment with a doctor who has skills and experience in treating CF. CF requires regular follow-up with your healthcare professional, at least every three months. Call your healthcare professional if you have new or worsening symptoms, such as more mucus than usual or a change in the mucus color, lack of energy, weight loss, or severe constipation. Get medical care right away if you're coughing up blood, have chest pain or trouble breathing, or have severe stomach pain and bloating. Call 911 or your local emergency number or go to the emergency department at a hospital if: You're having a hard time catching your breath or talking. Your lips or fingernails turn blue or gray. Others notice that you're not mentally alert.

Source: www.mayoclinic.org ↗
02What you can do

You might want to take a friend or family member with you to the appointment to help you remember information. Before your appointment, make a list of: Symptoms and when they started. Include anything that makes symptoms worse or better. All medicines, vitamins, herbs and supplements that you or your child take. Include the doses. Family history, such as whether anyone in your family has cystic fibrosis. Treatment you or your child have had for CF, if any. Include what the treatment was and if it helped. Any other medical conditions and their treatments. Questions to ask your healthcare professional. Questions to ask may include: What is likely causing these symptoms? What kinds of tests are needed? What treatment do you recommend? I or my child have other health conditions. How will cystic fibrosis affect them? Are there any limits needed? Feel free to ask other questions during your appointment.

Source: www.mayoclinic.org ↗
03What Is Cystic Fibrosis?

Cystic fibrosis (CF) is a genetic disorder, which means you get it from your parents at birth. It affects your lungs, pancreas, and other organs. CF changes the way chloride (salt) moves through the cells of your body. This causes the mucus (which should be thin and slippery) in various organs to become thick and sticky. Over time, this thick mucus builds up inside your airways, making it hard to breathe. The mucus traps germs and leads to infections and inflammation. It can also cause severe, long-term damage to the lungs and lead to respiratory failure (inability to breathe normally) and death. In the pancreas, the thick mucus caused by CF prevents the release of digestive enzymes when you eat. This leads to malnutrition and poor growth. CF can also cause liver disease, reproductive problems, and cystic fibrosis-related diabetes (CFRD). More than 40,000 people in the U.S. live with CF. Doctors diagnose about 1,000 new cases each year. Today, more than half of the CF population is aged 18 or older, and new treatments have expanded the life expectancy by decades.

Source: www.webmd.com ↗
04How Strong Is the Evidence for Alyftrek?

Based on the current clinical studies, Alyftrek is a safe and effective treatment for people with cystic fibrosis. The Cystic Fibrosis Foundation published a CFTR modulator therapy care guideline in 2018. Alyftrek is not included in these guidelines since it was approved by the FDA after these guidelines were published.

Source: www.webmd.com ↗
05Is there anything else I need to know about a sweat test?

In rare cases, conditions other than CF may result in high chloride levels on a sweat test. These conditions include hypothyroidism , nephrogenic diabetes insipidus , and Addison disease .

Source: medlineplus.gov ↗
Research context

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Research and Statistics: Who Has Cystic Fibrosis?

About 40,000 people are living with cystic fibrosis in the United States, and there are approximately 105,000 people with CF worldwide. (3) More than 75 percent of people with the disease are diagnosed by age 2, and more than half of all people living with cystic fibrosis are 18 or older. CF occurs predominantly in white populations, at a rate of 1 in 2,500 births. Between 2 and 5 percent of white people are carriers of the CFTR gene variant but have no overt clinical signs of disease. The disease is less common among African Americans, occurring at the much lower frequency of approximately 1 out of 17,000 births. (15) CF gene variants are most prevalent in persons of northern and central European ancestries or of Ashkenazi Jewish descent. They are rarely found in Native Americans, Asians, or native Africans. (16) CF is equally common among men and women, but women patients fare significantly worse than male patients with the disease. The median survival age for female CF patients is about three years younger than it is for men, but the reasons for the poorer survival rates among women are not completely understood. (17)

Source: everydayhealth.com ↗
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