Islet Hormone and Incretin Secretion in Cystic Fibrosis after Four Months of Ivacaftor Therapy

Am J Respir Crit Care Med. 2019 Feb 1;199(3):342-351. doi: 10.1164/rccm.201806-1018OC.


Rationale: Diabetes is associated with worse cystic fibrosis (CF) outcomes. The CFTR potentiator ivacaftor is suggested to improve glucose homeostasis in individuals with CF.

Objectives: To test the hypothesis that clinically indicated ivacaftor would be associated with improvements in glucose tolerance and insulin and incretin secretion.

Methods: Oral glucose tolerance tests, mixed-meal tolerance tests, and glucose-potentiated arginine tests were compared preivacaftor initiation and 16 weeks postivacaftor initiation in CF participants with at least one CFTR gating or conductance mutation. Meal-related 30-minute (early phase) and 180-minute incremental area under the curves were calculated as responses for glucose, insulin, C-peptide, and incretin hormones; glucagon-like peptide-1; and glucose-dependent insulinotropic polypeptide. First-phase insulin secretion, glucose potentiation of arginine-induced insulin secretion, and disposition index were characterized by glucose-potentiated arginine stimulation tests.

Measurements and main results: Twelve subjects completed the study: six male/six female; seven normal/five abnormal glucose tolerance (oral glucose tolerance test 1-h glucose ≥155 and 2-h glucose <200 mg/dl); of median (minimum-maximum) age (13.8 yr [6.0-42.0]), body mass index-Z of 0.66 (-2.4 to 1.9), and FEV1% predicted of 102 (39-122). Glucose tolerance normalized in one abnormal glucose tolerance subject. Ivacaftor treatment did not alter meal responses except for an increase in early phase C-peptide (P = 0.04). First-phase (P = 0.001) and glucose potentiation of arginine-induced (P = 0.027) insulin secretion assessed by acute C-peptide responses improved after ivacaftor treatment. Consistent with an effect on β-cell function, the disposition index relating the amount of insulin secreted for insulin sensitivity also improved (P = 0.04).

Conclusions: Insulin secretion improved following 4 months of clinically indicated ivacaftor therapy in this relatively young group of patients with CF with normal to mildly impaired glucose tolerance, whereas incretin secretion remained unchanged.

Keywords: cystic fibrosis; diabetes; insulin; ivacaftor.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aminophenols / blood
  • Aminophenols / therapeutic use*
  • Blood Glucose / drug effects*
  • C-Peptide / blood
  • C-Peptide / drug effects
  • Child
  • Cystic Fibrosis / blood*
  • Cystic Fibrosis / drug therapy*
  • Female
  • Follow-Up Studies
  • Glucose Tolerance Test
  • Humans
  • Incretins / blood*
  • Insulin / blood
  • Male
  • Quinolones / blood
  • Quinolones / therapeutic use*
  • Young Adult


  • Aminophenols
  • Blood Glucose
  • C-Peptide
  • Incretins
  • Insulin
  • Quinolones
  • ivacaftor