Glucagon-Like Peptide 1 Agonist Use in an Adult With Cystic Fibrosis-Related Diabetes and Metabolic Syndrome

Cystic fibrosis (CF)-related diabetes (CFRD) is a common extrapulmonary complication of CF, with increasing prevalence. As individuals with CF live longer, obesity rates are increasing, leading to an emerging phenotype called CFRD with metabolic syndrome. The objective of this report is to describe the use of semaglutide in an adult with CFRD, obesity, and clinical insulin resistance.

A 32-year-old man with CF, pancreatic insufficiency, obesity, and poorly controlled CFRD presented with worsening blood sugar control, increasing insulin requirements, and a strong family history of metabolic syndrome. His body mass index was 38.5 kg/m², and his hemoglobin A1c level ranged from 9.4% to 11.4%. He reported difficulty adhering to insulin therapy and concerns regarding weight and body image. A continuous glucose monitor was initiated; however, it did not significantly improve glycemic control. Given his metabolic profile and desire to lose weight, semaglutide was introduced and gradually increased over 5 months. This improved the hemoglobin A1c level by 5.7%, lowered the mean glucose levels, reduced the body mass index to 33.4 kg/m², and decreased insulin requirements without adverse effects.

Although insulin is the primary treatment for CFRD, glucagon-like peptide 1 receptor agonists may provide additional benefits in carefully selected patients.

This case highlights the potential benefits of glucagon-like peptide 1 receptor agonists in CFRD with metabolic syndrome and emphasizes the need for further investigation.