Association of CFRD development among females with CF who use hormonal contraception

Research suggests the effects of combined (containing both estrogen and progestin) hormonal contraception (CHC) can negatively affect insulin sensitivity. This study aims to better understand the associations between hormonal contraceptive (HC) use, prevalence of existing CFRD, and incidence of developing CFRD in females with CF.

Between January 2021 to April 2022, we recruited females ages 18-45 years with CF from 10 CF centers to complete a retrospective online questionnaire regarding contraceptive use from 2008 to survey completion year. We linked survey responses to the CF Foundation's Patient Registry (CFFPR) covering the same years as the survey. We examined potential associations with CFRD, incidence of new CFRD, and CFRD's association with HC using Cox regression adjusted for age, body mass index, CF modulator use, and educational level.

In our observational cohort of 551 persons completing the survey and with information in the CFFPR, the incidence of reported CFRD was low at 145 cases per 3674 person-years (p-y). Neither BMI nor age were found to be associated with CFRD incidence. Elevated plasma glucose, 2-hour oral glucose tolerance test, and HbA1c were all significantly associated with CFRD. Compared to no modulator use, CF modulator use was associated with a similar rate of CFRD (HR 1.04, 95% CI 0.50 to 2.17). Among non-modulator users, CFRD incidence was significantly associated with CHC use (HR = 1.53, 95% CI 1.03 to 2.27).

In this retrospective observational study, CHC was associated with a higher incidence of CFRD among non-modulator users.