Cystic fibrosis related diabetes - a new perspective on the optimal management of postprandial glycemia

Abstract not availableS. Perano, C.K. Rayner, J. Couper, J. Martin, M. Horowit

Comparison of two pancreatic enzyme products for exocrine insufficiency in patients with cystic fibrosis

Background: Zenpep (APT-1008) is a pancreatic enzyme product for the treatment of exocrine pancreatic insufficiency (EPI) associated with cystic fibrosis (CF). Methods: Zenpep and Kreon, both containing 25,000 lipase units, were compared in a randomised, double-blind, crossover, non-inferiority study for CF-associated EPI in patients aged ≥12 years. Patients on a standardised diet and stabilised treatment were randomised to two treatment sequences: Zenpep/Kreon or Kreon/Zenpep. The primary efficacy endpoint was the coefficient of fat absorption over 72 h (CFA-72 h). Results: 96 patients (mean age 19.2 years, 60.4% males) were randomised with 83 completers of both sequences comprising the efficacy population. Zenpep demonstrated non-inferiority and equivalence to Kreon in fat absorption (LS mean CFA-72 h: Zenpep, 84.1% [SE 1.1] vs. Kreon, 85.3% [SE 1.1]; p = 0.297). Safety and tolerability were similar. Conclusions: Zenpep is comparable with Kreon in efficacy and safety for the treatment of adolescents and adults with CF-associated EPI. NCT0164139

Pancreatic enzyme supplementation improves the incretin hormone response and attenuates postprandial glycemia in adolescents with cystic fibrosis: a randomized crossover trial

Published Online: March 26, 2014CONTEXT: Cystic fibrosis-related diabetes is characterized by postprandial, rather than fasting, hyperglycemia. Gastric emptying and the release of the incretin hormones [glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP)] are central to postprandial glycemic control. Lipolysis is required for fat to slow gastric emptying and stimulate incretin release. OBJECTIVE: We aimed to determine the effect of pancreatic enzyme replacement therapy (PERT) on postprandial glycemia in adolescents with cystic fibrosis (CF). DESIGN: This was a double-blinded randomized crossover trial. Subjects consumed a high-fat pancake, with either PERT (50 000 IU lipase) or placebo. Gastric emptying was measured by a breath test and blood sampled frequently for plasma blood glucose, insulin, glucagon, GLP-1, and GIP. Data were also compared with seven healthy subjects. PARTICIPANTS: Fourteen adolescents (13.1 ± 2.7 y) with pancreatic-insufficient CF and seven healthy age-matched controls participated in the study. MAIN OUTCOME MEASURE: Postprandial hyperglycemia was measured as peak glucose and area under the curve for blood glucose at 240 minutes. RESULTS: CF subjects had postprandial hyperglycemia compared with controls (area under the curve, P < .0001). PERT reduced postprandial hyperglycemia (P = .0002), slowed gastric emptying (P = .003), and normalized GLP-1 and GIP secretion (P < .001 for each) when compared with placebo, without affecting insulin. CONCLUSION: In young people with pancreatic insufficient CF, PERT markedly attenuates postprandial hyperglycemia by slowing gastric emptying and augmenting incretin hormone secretion.Shiree J. Perano, Jennifer J. Couper, Michael Horowitz, A. James Martin, Stamatiki Kritas, Thomas Sullivan, and Chris K. Rayne

First Australian report of vitamin D-dependent rickets type I

Nobuaki Ito, Alexia S Peña, Shiree Perano, Gerald J Atkins, David M Findlay, Jennifer J Coupe

Analysis of Open Innovation Intermediaries Platforms by considering the Smart Service System perspective

Open Innovation and Services Science are two distinct paradigms that share some principles 0. While some attempts to investigate open innovation according to a service science perspective exist, there is currently a gap with regards to the analysis of intermediaries of open innovation according to a service science perspective and even more regarding to recent trends about smart service system. This paper aims to fill this gap and, to this purpose, we present two interesting and original results. After an analysis of the key features of Open Innovation Intermediaries, we discuss a characterization of these intermediaries as service systems by mapping their features on the ten fundamental concepts of a service system. Next we propose a new model that goes in the direction of the convergence between service and cognitive system (smart service system) and aims at overcoming some traditional issues of the intermediaries. The new model foresees the distribution of Open Innovation Intermediaries features, enhanced with a set of cognitive assistants to the stakeholders within open innovation processes, and proposes the adoption of responsible innovation frameworks as a base to add right and responsibilities to cognitive assistants

Gastric emptying is more rapid in adolescents with type 1 diabetes and impacts on postprandial glycemia

CONTEXT: Gastric emptying is a critical determinant of postprandial glycemic control in health and type 1 diabetes. There are few studies that assess the relationship between gastric emptying and postprandial glycaemia in adolescents with type 1 diabetes. OBJECTIVE: The objectives of the study were to quantify gastric emptying in adolescents with type 1 diabetes and examine its relationship to postprandial glycaemia and autonomic function. DESIGN: This was a case-control study. Gastric half-emptying time of a solid meal was measured by a (13)C-octanoate breath test. Cardio-autonomic function was measured by heart rate variability. Chronic and postprandial gastrointestinal symptoms were evaluated by questionnaire and visual analog scales. Blood glucose concentrations were monitored frequently during the study. SETTING: The study was conducted at a tertiary pediatric hospital in South Australia. PARTICIPANTS: Thirty adolescents (aged 15 ± 2.5 y) with type 1 diabetes and age- and sex-matched controls (gastric emptying, n = 20; heart rate variability, n = 135) participated in the study. MAIN OUTCOME: Gastric half-emptying time was the main outcome in the study. RESULTS: Gastric emptying was more rapid in subjects with type 1 diabetes than controls [median half emptying time 78 (interquartile range 61-99) vs 109 (interquartile range 71-124) min, P = .02]. The postprandial rise in blood glucose at 60 minutes was strongly related to gastric half-emptying time (R = -0.65, P = .0001). Gastric emptying was slower in subjects with fasting hyperglycemia but was not related to heart rate variability. Nausea, bloating, and anxiety were related to fasting glycemia (P = .03). CONCLUSION: Rapid gastric emptying is a major determinant of postprandial glycemia in adolescents with type 1 diabetes. This observation has significant implications for therapy.Shiree J. Perano, Chris K. Rayner, Stamatiki Kritas, Michael Horowitz, Kim Donaghue, Christine Mpundu-Kaambwa, Lynne Giles, and Jenny J. Coupe