Current diabetes therapy and use of diabetes technology in people living with cystic fibrosis-related diabetes (CFRD): Insights from the DPV network

BACKGROUND: Cystic fibrosis-related diabetes (CFRD) is a common comorbidity in cystic fibrosis (CF), significantly impacting morbidity and mortality. Recent advancements in therapy and diabetes technology have transformed the management of CF and diabetes. This study aims to assess the evolution of CFRD and its treatment over the past few decades in a large cohort receiving routine care. METHODS: Longitudinal data of 1039 persons with CFRD (median age at CFRD onset (Q1;Q3): 15.7 (13.2-19.9) years; 57.2% females) from the Diabetes Prospective Follow-up (DPV) database between 2000 and 2023 were analyzed. Changes in demographics, anthropometrics and diabetes therapy were studied using adjusted linear and logistic regression models. RESULTS: BMI-SDS at CFRD diagnosis increased from -0.62 (-1.78;+0.12) in 2000 to -0.45 (-0.81; +0.36) in 2023 (p = 0.002), while age at CFRD diagnosis decreased from 14.8 (13.4;19.1) years in 2000 to 12.5 (11.3;14.7) years in 2023 (p = 0.033). Pharmacological CFRD treatment has changed over the past years. Insulin monotherapy increased from 65.1% to 78.7% (p = 0.044), while OAD/GLP-1 RA-only use decreased (16.9% to 0.7%, p < 0.001). Insulin pump therapy was documented in 26.2% of people with CFRD (PwCFRD) in 2023. The use of CGM increased continuously since 2015, with 76.7% of participants using CGM in 2023 (p < 0.001). Proportion with underweight dropped from 34.3% in 2000 to 14.2% in 2023 (p < 0.001), while overweight increased during this period from 1.5% to 6% (p = 0.011). CONCLUSIONS: Insulin monotherapy and in particular diabetes technology is used more frequently. Improvements in CF therapy are reflected in increasing BMI-SDS and a decrease in the proportion of underweight people with CFRD.