183 Intermittent exogenous insulin may prevent progression of dysglycemia in pre-diabetic adults

Objectives In prediabetes, pancreatic beta cell function may be preserved by intermittent exogenous insulin support, potentially delaying the onset of diabetes. We assessed whether this could be employed in CF, where the development CFRD greatly increases the treatment burden, morbidity and ultimately overall mortality. Methods We studied 5 male prediabetic (defined on the basis of an abnormal continuous glucose monitoring (CGM) result and normal 2-hour oral glucose tolerance test (OGTT)) CF patients who were in an otherwise clinically stable state. Their clinical and glycaemic parameters (based on CGM) were measured for 3 months after 14 days of Detemir treatment. Results CGM devices were well tolerated and only one data collection point was incomplete (day 18 CGM result). Glucose profiles improved in the first few weeks after treatment, and dysglycaemia had resolved entirely in 2 patients by day 64. There was no significant change in FEV1 or HbA1c. ScreeningDay 18Day 34Day 64Day 94Mean % time glucose profile raised17%12%7%12%9%Mean FEV1%76%75%77%76%73% Conclusion This study suggests that pre-diabetic adult CF patients treated with a short (2-week) course of insulin may experience extended periods of improved glucose control. These effects seem most pronounced for the immediate few weeks after treatment is received. This raises the prospect that intermittent insulin regimes may delay the progression of dysglycaemia in this increasingly common complication of the CF condition.