B45-17 Sglt2 Inhibitors Reduce Mortality and Pulmonary Complications in Adults With Cystic Fibrosis and Diabetes: A Multicenter Propensity-matched Study

Abstract Rationale Cystic fibrosis-related diabetes (CFRD) is associated with increased pulmonary infections, hospitalizations, and mortality. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used in diabetes, yet their impact on outcomes in patients with CF and diabetes is unknown. Objectives To evaluate whether SGLT2 inhibitor use in adults with CF and diabetes is associated with improved clinical outcomes compared with diabetic CF patients not treated with SGLT2 inhibitors. Methods A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Adults (≥18 years) with CF (ICD-10 E84) and diabetes (E08-E13) were identified. Cohort A included those receiving SGLT2 inhibitors within 1 year before or after diabetes diagnosis; Cohort B included patients treated with other antihyperglycemics without SGLT2 use. Patients with lung transplantation or CFTR modulators were excluded. Outcomes assessed over 5 years from index event included inpatient admission, emergency visits, respiratory failure, pneumonia, and all-cause mortality. Propensity score matching (1:1) was performed across demographics, comorbidities, medications, and laboratory parameters, resulting in 555 patients per group. Kaplan-Meier survival and risk analyses were performed. Results After matching, baseline characteristics were well balanced (standardized mean differences 0.1). SGLT2 use was associated with significantly lower inpatient hospitalization (27.9% vs 42.4%, risk ratio RR 0.66, p = 0.006), pneumonia (17.6% vs 24.9%, RR 0.71, p = 0.016), and mortality (9.7% vs 24.0%, RR 0.41, p 0.001). Kaplan-Meier curves demonstrated improved 5-year survival in the SGLT2 group (84.9% vs 69.5%, p 0.001; HR 0.45, 95% CI 0.33-0.62). No significant differences were observed for emergency visits or respiratory failure. Conclusions Among adults with cystic fibrosis and diabetes, SGLT2 inhibitor therapy was associated with significantly lower mortality, pneumonia, and hospitalization rates compared with non-users. These real-world findings suggest a potential protective cardiopulmonary effect of SGLT2 inhibitors in CFRD and support the need for prospective clinical trials. This abstract is funded by: None