B45-18 Glp-1 Receptor Agonists Reduce Hospitalization, Respiratory Failure, and Mortality in Adults With Cystic Fibrosis and Diabetes: A Real-world Propensity-matched Study

Abstract Rationale Cystic fibrosis-related diabetes (CFRD) is associated with increased pulmonary exacerbations and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for diabetes management, but their impact on clinical outcomes in CFRD remains unknown. Objectives To determine whether GLP-1 RAs reduce hospitalization, respiratory complications, and mortality in adults with CF and diabetes. Methods A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network (160 healthcare organizations). Adults ≥18 years with cystic fibrosis (ICD-10 E84) and diabetes (E08-E13) were included. The GLP-1 group received liraglutide, semaglutide, dulaglutide, exenatide, lixisenatide, albiglutide, or tirzepatide within 1 year before or after diabetes diagnosis. The comparison group received other antihyperglycemic therapies but no GLP-1 agonists. Patients with lung transplant or CFTR modulator use were excluded. Propensity score matching (1:1) was performed on demographics, BMI, HbA1c, comorbidities, and medication use, resulting in 662 patients per group. Outcomes over 5 years included inpatient hospitalization, emergency visits, respiratory failure (J96), pneumonia, and all-cause mortality. Risk ratios and Kaplan-Meier survival analyses were calculated. Results Compared to non-GLP-1 therapy, GLP-1 use was associated with significantly reduced: Inpatient hospitalization: 27.8% vs 40.2% (RR 0.69; HR 0.71; p = 0.025). Respiratory failure: 11.7% vs 19.6% (RR 0.60; HR 0.71; p = 0.029). Pneumonia: 15.8% vs 24.4% (RR 0.65; HR 0.73; p = 0.039). All-cause mortality: 7.4% vs 14.8% (RR 0.50; HR 0.61; p = 0.005). Emergency department visits were lower but not statistically significant (25.4% vs 31.6%; p = 0.085). Survival probability remained higher in the GLP-1 group across all outcomes. Conclusions In adults with cystic fibrosis and diabetes, GLP-1 receptor agonist therapy is associated with reduced hospitalization, respiratory failure, pneumonia, and mortality. These findings suggest potential pulmonary and metabolic benefits of GLP-1 therapy in CFRD and support further prospective clinical evaluation. This abstract is funded by: None