Understanding the link between cystic fibrosis-related diabetes and lung health

Project Duration – 2 years

What is the research about?

Despite advances in new therapies, people with cystic fibrosis (CF) continue to experience health complications that can affect their health and add to the daily burden of treatment, One of these complications is CF-related diabetes (CFRD). More than half of adults with CF will develop CFRD, and many require insulin treatment.

Pulmonary exacerbations, when lung symptoms suddenly worsen and require intensive treatment, also remain common. They can lead to hospitalisation, reduced quality of life and permanent loss of lung function.

Dr Bernadette Prentice and her team will use data from the national BEAT-CF program, which contains detailed health information from more than 950 Australians with CF, to investigate whether CFRD is linked to a greater risk of pulmonary exacerbations and a slower recovery after these episodes.

The team will also investigate whether HbA1c, a measure of longer-term glucose control, can help predict the risk of pulmonary exacerbations, and whether better blood sugar control is associated with faster recovery from these episodes. The findings will help build a clearer picture of how CFRD affects lung health and provide the foundation for a future clinical trial investigating different ways to treat CFRD and prevent pulmonary exacerbations.

Why does this matter for people with CF?

CFRD is one of the most common complications of CF and can add significantly to an already demanding treatment routine. It can also affect lung health and overall wellbeing.

Emerging evidence from the BEAT-CF study suggests that people with CF who require insulin treatment may take longer to recover lung function following pulmonary exacerbations, even when receiving modern CFTR modulator therapies. However, the relationship between CFRD, blood sugar control and lung health is not yet well understood.

This research will help identify whether people with CFRD, particularly those requiring insulin, are at greater risk of pulmonary exacerbations or poorer recovery. Understanding these patterns could help clinicians identify people who may need closer monitoring or different approaches to treatment.

The research will also help identify which groups of people with CFRD should be prioritised for future clinical trials and which outcomes should be measured.

What will the research do?

The research team will:

• Investigate whether people with insulin-treated CFRD experience more frequent pulmonary exacerbations than people with CF without diabetes.
• Examine whether CFRD and insulin treatment are associated with more severe exacerbations, greater loss of lung function or slower recovery.
• Investigate whether blood sugar control, measured through HbA1c levels, can help identify people who may benefit from different approaches to CFRD management.
• Use the findings to identify priority patient groups and outcomes for a future CFRD clinical trial.

What could happen next?

The findings will provide the evidence needed to design a prospective, multicentre clinical trial focused on improving treatment for CFRD. This will involve developing the trial protocol, identifying the people most likely to benefit from different interventions and determining the most meaningful outcomes to measure. The BEAT-CF data will help researchers estimate how many participants will be needed and how the trial should be designed.

If future trials demonstrate that new approaches improve outcomes, the findings could ultimately inform changes to CF clinical guidelines and standards of care.

The goal is to better understand CFRD, identify people at greatest risk and develop more personalised approaches that could improve both diabetes management and lung health.