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Agreement Between HbA1C and Continuous Glucose Monitoring-Derived Glycemic Metrics in Adults With Cystic Fibrosis

Ammar Ahmed1, Jaspreet Batth1, Qi Wang2

  • 1Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|April 22, 2026
PubMed

Insights

HbA1c accurately reflects glucose levels in adults with cystic fibrosis related diabetes (CFRD), as shown by continuous glucose monitoring (CGM) data. Integrating both HbA1c and CGM improves CFRD management.

Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Pulmonology

Background:

  • Cystic fibrosis related diabetes (CFRD) is a common complication of cystic fibrosis.
  • Accurate glycemic control assessment is crucial for managing CFRD.
  • The reliability of HbA1c in reflecting mean glycemia in CFRD patients, especially with continuous glucose monitoring (CGM) and modern CFTR modulator therapies, is not well-established.

Purpose of the Study:

  • To evaluate the reliability of HbA1c in assessing glycemic control in adults with CFRD.
  • To compare HbA1c values with continuous glucose monitoring (CGM) metrics in this population.
  • To determine if HbA1c correlates with mean glucose levels derived from CGM in CFRD patients.

Main Methods:

  • Retrospective cross-sectional study at a single CF center.
  • Included adults with confirmed CFRD and paired laboratory HbA1c and CGM data (≥30 days, ≥70% active sensor time).
  • Excluded individuals with conditions affecting HbA1c reliability (e.g., anemia, CKD, pregnancy).

Main Results:

  • Forty-nine adults with CFRD were analyzed (mean age 43.9 years).
  • HbA1c showed strong correlations with glucose monitoring indicator (GMI) (r=0.90) and mean sensor glucose (r=0.90).
  • Bland-Altman analysis indicated minimal bias (+0.30%) and no proportional bias between HbA1c and CGM-derived glucose.

Conclusions:

  • HbA1c closely reflects CGM-derived mean glycemia in adults with established CFRD.
  • CGM metrics offer complementary clinical insights.
  • Combining HbA1c and CGM data may enhance CFRD monitoring and treatment decisions.
Abstract

Keywords:
CFTR modulator therapyGlucose Management Indicatorcontinuous glucose monitoringcystic fibrosis related diabetesglycemic monitoring in CFRDhemoglobin A1C

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