Discussion
CFRD, lung disease, impaired nutritional status, insulin insufficiency
CATABOLIC STATE, LUNG DISEASE
In this non-randomized controlled clinical trial, the use of SAP therapy in insulin-requiring adults with CFRD was associated with a significant improvement in glycemic control, expressed as HbA1c, percent of TIR, and mean glucose levels. In addition, SAP therapy induced significant and beneficial changes in body composition with relevant increases in fat-free mass.Scully KJ et al. recently demonstrated a significant improvement in mostly all CGM-derived glucose control parameters in a 3-month follow-up period after switching 13 adolescents and adults with CFRD from MDI to insulin pumps (We also demonstrated that an optimized glycemic control, obtained with such a tailored therapy, can be an effective strategy in obtaining a beneficial impact on body composition, as shown by the increased fat-free mass and reduced fat mass in participants who switched to SAP. This effect along with the improved glycemic control is of major relevance in people with CF, and especially in those with CFRD in whom the catabolic state induced by insulin insufficiency increase the risk of poor nutritional status (To our knowledge, this is the first study that provides evidence of the beneficial effects of SAP in terms of both glycemic control and body composition in people with CFRD. The main limitation is the non-randomized study design leading to important differences in the baseline characteristics of the two groups, which, however were addressed by using overlap weighting, an efficient procedure that mimics the attributes of randomized clinical trials. Furthermore, impaired glycemic control is associated with the progression of lung disease and impaired nutritional status (In conclusion, this study shows that SAP therapy leads to a significantly better glycemic control than MDI therapy, resulting in increased fat-free mass and suggesting that it may be particularly useful in treating people with CFRD. However, further studies are needed to assess the effect of optimized glucose control with SAP therapy and the associated improvement in nutritional status on long-term outcomes, such as lung function, CF- and CFRD related morbidity, quality of life, and mortality in these individuals.