Can Oral Therapy Replace Insulin In Diabetes for Those with Cystic Fibrosis?

Diabetes is a chronic condition that affects the everyday lives of those who have it - but when they have other diseases as well, the difficulty is intensified. For those who have cystic fibrosis-related diabetes, treatment can be very complicated. However, recent studies have shown that oral therapy is equally effective and safe as insulin for cystic fibrosis-related diabetes, offering patients further options and control over their treatment regimen.

Oral vs. insulin

According to an open-label, comparative intervention trial, results have shown that those with cystic fibrosis-related diabetes who have taken oral repaglinide for two years exhibit significant improvements in HbA1c and pulmonary function. So much so, that these findings are comparable to those who had been treated with human insulin therapy.

Manfred Ballmann, MD, of the pediatric clinic at University Medicine Rostock, Germany, along with his many colleagues, wrote about the study, "if cystic-fibrosis-related diabetes is diagnosed, treatment guidelines recommend insulin therapy with multiple daily injections, although there are no data to assess whether this is the optimum treatment. Oral antidiabetic therapies might be as effective as insulin for some patients and could lessen the additional burden of care in patients already undergoing complex and demanding therapy."

Collecting data to study

To find test whether the results of the two approaches were indeed comparable, Ballman and his colleagues assessed information they had attained from 71 patients who have cystic fibrosis, all of whom were over ten years old. They analyzed the reactions to two consecutive oral glucose tolerance tests that had been taken in the last six months. The patients had visited one of the 30 cystic fibrosis centers monitored in Austria, Germany, France, or Italy between March 2002 and December 2009.

To these patients, the researchers either prescribed "oral repaglinide therapy (at a max dose of 4 mg three times per day (n = 33; mean age, 22 years; 61% female; mean HbA1c, 6.4%) or multiple daily injections of regular human insulin (Actrapid HM, Novo Nordisk) three times per day 20 to 30 minutes before each meal (n = 41; mean age, 22 years; 22 girls and women; mean HbA1c, 6.4%) for a mean of 24 months."

After they had been on their selected treatment regimens for three months, they were required to attend follow-up visits, allowing the researchers to analyze their reactions to the medications at every step of the way.

Results of the study

The researchers considered primary outcomes to be the alterations that came in HbA1c between the baseline and two years and secondary outcomes were considered to be the changes that took place in HbA1c between baselines and twelve months, forced expiratory volume in 1 second, mean alterations in z score of the BMI, and forced vital capacity from baseline to anywhere between one to two years.

The patients were divided between the thirty who had been taking repaglinide and the thirty-seven who had been taking insulin, and linear models were utilized to look into the changes both groups saw, in comparison to one another.
The mean final daily dose for repaglinide was found to be 2.6 mg per day, and 18.6 IU per day for insulin.

Read on to learn more about this important discovery.