Between the Guidelines: Variability in Management of Patients With Cystic Fibrosis and Dysglycemia

Abnormalities in glucose metabolism detected by oral glucose tolerance test occur frequently in people with cystic fibrosis (CF) and can have clinical implications. Cystic fibrosis related diabetes (CFRD) guidelines don't address management of dysglycemia in people with CF without diabetes.

We developed a 34-question survey to query pre-CFRD management practices among US based endocrinologists. Respondents were current or former participants in the EnVision-CF Program. We analyzed responses quantitatively and qualitatively. Data are presented descriptively.

The most common next step after abnormal oral glucose tolerance test was placing a continuous glucose monitor, though insurance coverage was a barrier to use. Despite the high rate of continuous glucose monitor use, the specific metrics deemed most important to providers varied. Endocrinologists cited multiple factors influencing their decision to treat pre-CFRD, including CF-specific and general diabetes goals. Most respondents reported at least sometimes considering use of medication in management of pre-CFRD. Common treatment options were basal insulin alone (75%) or bolus insulin alone (60%). Many also considered noninsulin medications including glucagon-like peptide-1 agonists and biguanides.

This survey of US endocrinologists with CF expertise offers valuable insight into current practices for managing pre-CFRD, while highlighting considerable variation in clinical practice. Respondents agreed on key long-term outcomes as priorities for future care, but management differed regarding use and choice of diagnostic tools and medications. This study serves as an important indicator of the need for ongoing research to guide development of evidence-based guidelines in this area to better inform clinical practice.