- βSensor-augmented pump therapy reduced average blood glucose by 32 mg/dL more than daily injections over 24 months
- βTime in Range improved by 19.3 percentage points, potentially helping patients meet the ADA's 70% TIR goal
- βPatients using insulin pumps gained approximately 12 lbs of lean muscle mass β addressing a core physical complication of cystic fibrosis
| Country | Italy |
| Journal | Frontiers in endocrinology |
| Year | 2023 |
| Authors | Grancini, Alicandro, Porcaro |
| PMID | 37720540 |
A study from Italy, conducted at the prestigious Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, offers important new evidence for people living with cystic fibrosis-related diabetes (CFRD) β a condition that affects 40β50% of adults with cystic fibrosis (CF). The research examined whether upgrading patients from multiple daily injections (MDI) to sensor-augmented pump (SAP) therapy could improve both blood sugar control and body composition over two years.
What Is Cystic Fibrosis-Related Diabetes?
CFRD is a unique form of diabetes caused by partial or complete insulin deficiency stemming from CF-related damage to the pancreas. Unlike Type 1 or Type 2 diabetes, CFRD comes with an added challenge: poor blood sugar control triggers a catabolic (tissue-breakdown) state that worsens the nutritional deficiencies and muscle loss already caused by CF itself. Managing CFRD well is therefore critical not just for blood sugar, but for overall survival and quality of life.
What the Italian Researchers Did
Of 46 participants offered the switch from MDI to SAP therapy, 20 accepted the upgrade while 26 continued with standard multiple daily injections. All participants were followed for 24 months. The SAP group also received a structured diabetes education program alongside their new technology. Researchers used advanced statistical methods (propensity score weighting) to ensure fair comparisons between the two groups.
Key Findings β In US-Friendly Numbers
- HbA1c improved by 1.1% in the SAP group versus virtually no change (β0.1%) in the MDI group β a clinically meaningful difference of 1.0% between groups.
- Average blood glucose dropped by 32 mg/dL more in the SAP group compared to MDI patients.
- Time in Range (TIR) increased by 19.3 percentage points in SAP users β meaning patients spent nearly one-fifth more of their day with blood sugar in a healthy range (typically 70β180 mg/dL per US guidelines).
- Fat-free mass (muscle and lean tissue) increased by 5.5 kg (about 12 lbs) more in the SAP group β a remarkable finding given that muscle loss is a core problem in CF.
How This Compares to US Guidelines
The American Diabetes Association (ADA) recommends a TIR goal of at least 70% for most diabetes patients. The 19.3% TIR improvement seen in Italian SAP users could be the difference between dangerously uncontrolled CFRD and meeting that benchmark. The ADA also recognizes continuous glucose monitoring (CGM) and insulin pump therapy as best-practice tools β this Italian trial reinforces that recommendation specifically for the CFRD population.
Why This Matters for US Patients
An estimated 20,000+ Americans live with cystic fibrosis, and roughly half will develop CFRD. Despite this, CFRD often receives less research attention than Type 1 or Type 2 diabetes. This Italian study is one of the strongest real-world demonstrations that advanced insulin delivery technology doesn't just lower A1c in CFRD β it may actually help rebuild the muscle mass that CF destroys. For US patients and their care teams, this is a compelling argument for discussing SAP therapy upgrades at their next endocrinology appointment, especially if current injections are not meeting glycemic targets.
Study Citation
Grancini, Alicandro, Porcaro. Effects of insulin therapy optimization with sensor augmented pumps on glycemic control and body composition in people with cystic fibrosis-related diabetes. Frontiers in Endocrinology, 2023. PMID: 37720540. DOI: 10.3389/fendo.2023.1228153