Effects on Metabolic Control and Body Composition of Insulin Therapy Optimization in Patients with Cystic Fibrosis-Related Diabetes

Cystic fibrosis related diabetes (CFRD) occurs in 19% of adolescents and 40-50% of adults with CF. The partial to complete insulin deficiency leads not only to hyperglycaemia, but also to loss of muscle mass and induction of a catabolic state. Therefore, insulin is the only recommended therapy for CFRD. Continuous subcutaneous insulin infusion (CSII) has been associated to improved glycaemic control in CFRD in small studies, if compared to multiple daily injections (MDI) , mostly due to better coverage of dietary requirements of these patients (high calories, not carbohydrate restrictions, several snacks) . The aim of this study is to evaluate the effects of insulin therapy optimization combined to a structured educational program (training to Sensor Augmented Pump -SAP- therapy and carbohydrates counting) on metabolic control and body composition in patients with CFRD requiring insulin therapy. 22 patients agreed to participate in the program and, at the end of it, switched to SAP therapy. 29 patients continued the outpatient checks without joining the program. Patients of both groups were re-evaluated 2 years after baseline. Patients in the educational program group demonstrated a substantial improvement in glycometabolic control (HbA1c 7.4±1.4 vs. 6.5±0.6%; average blood glucose 8.5±1.6 vs. 7.4±1.1 mmol/L; Glucose management indicator - GMI 7.2±0.9 vs. 6.5±0.5%; time in range - TIR 64.2±18.0 vs. 80.38±10.1%; time above range - TAR 31.0±18.8 vs. 16.2±9.1%; time below range - TBR 4.76±3.5 vs. 3.0±2.0%, P<0.05) and in body composition, assessed with bioimpedance (fat free mass - FFM 78.9±8.6 vs. 85.1±7.0%, total body water - TBW 57.9±6.3 vs. 63.2±6.7 L, P<0.05) . The same parameters didn’t differ from basal to final evaluation in the control group. In conclusion, a structured program resulting in therapy optimization leads to a significative improvement in glycometabolic control and, consequently, in body composition, due to insulin’s anabolic effect Disclosure V.Grancini: None. L.L.Porcaro: None. A.Gaglio: None. V.Resi: None. E.Orsi: None.