This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. CF related diabetes (CFRD) with fasting hypergylcemia occurs in about 15% of adult CF patients. Standard insulin therapy has relied primarily on meal coverage with rapid-acting insulin. Usually, basal insulin coverage is only provided overnight, with modest doses of NPH insulin. This practice ignores the established relationship between insulin deficiency and clinical deterioration of CFRD. Insulin deficiency leads to increased protein catabolism and fatty acid turnover, resulting in loss of weight and lean body mass. We hypothsize that 1) Basal insulin coverage with insulin glargine will improve hemoglobin A1c, weight, and muscle mass in patients with CFRD with fasting hyperglycemia, compared to traditional regimens with less basal insulin, and 2)because of the peakless action of insulin glargine, this will be accomplished without serious hypoglycemia. We will treat 20 adult CFRD patients in a randomized, cross-over study with 3 months of conventional insulin therapy with nighttime NPH and three months of insulin glargine therapy. At baseline, and at the beginning, middle and end of each 3 month study arm, subjects will be admitted to the GCRC to be weighed, for hemoglobin A1c determination, and to review the glucose and diet logs. A DEXA scan for body composition will be done at baseline and at the end of each 3-month period.
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