Though school-partnered interventions have the potential to improve health outcomes, data are limited to support their implementation for type 1 diabetes. The objective was to characterize barriers and facilitators (i.e., determinants) to implementing school-partnered collaborative care (SPACE), an intervention designed to improve care coordination, nurse education, and diabetes management in school. We conducted semistructured interviews with school nurses in two states. The interview guide was adapted from the Consolidated Framework for Implementation Research, which organizes determinants by the intervention, the individuals involved, the inner setting, (i.e., school district), the outer setting (i.e., external to the district), and the implementation processes. Major themes were summarized. We included 32 school nurses representing broad geographic regions, district sizes, and levels of nursing experience. School nurses reported that SPACE presented an advantage in care coordination compared with existing practice. Prominent barriers included (1) the intervention's complexity; (2) information sharing between schools and health systems; (3) high school nurses'caseloads, which may limit their availability; and (4) variable levels of parent engagement. Specific facilitators included (1) the intervention's adaptability and low cost, (2) high perceived need for interventions, (3) existing school resources that increase feasibility, (4) a focus on holistic outcomes which align with district priorities, and (5) relationships between school district nurses and leaders. Facilitators were perceived to be crucial to garnering buy-in from decision-makers within district leadership. The themes re-affirmed that school interventions for young people with type 1 diabetes are prioritized by school nurses. Implementation science frameworks can guide pre-implementation work and identify targets for implementation strategies which will mitigate barriers or leverage facilitators.
Childhood diabetes continues to rise, with wide variation across regions and income levels. We performed a cross-sectional analysis using Global Burden of Disease 2023 estimates for children aged 0-14 years across super regions, regions, and countries from 1990 to 2023. The primary objective was to characterize regional inequalities in incidence, mortality, and disability-adjusted life years, and to assess whether these inequalities are likely to persist in the future. Age-standardized incidence, mortality, and disability-adjusted life year rates were estimated per 100,000 population with 95% uncertainty intervals. Regional and national comparisons, temporal trend analyses, and socioeconomic gradient analyses were employed as core analyses. Risk factor attribution, the Quality of Care Index, Shapley additive explanations-based predictor contribution analysis, and Bayesian age-period-cohort forecasting were used as supportive analyses to interpret risk-attributable mortality patterns, care-related performance gaps, demographic and temporal contributors, and future incidence trajectories. From 1990 to 2023, childhood diabetes incidence increased in most regions, while mortality and disability declined overall. High-income North America had the highest incidence in 2023, whereas Western Sub-Saharan Africa had the greatest mortality and disability burden. Finland had the highest incidence, Qatar, Chile, and South Korea showed rapid incidence increases, and Nigeria had the highest mortality burden. Projections suggested stabilizing incidence in the United States but continued increases in China, India, Poland, Finland, and Qatar. Childhood diabetes shows persistent regional inequalities, highlighting the need for earlier diagnosis, reliable insulin access, and stronger pediatric diabetes systems in resource-limited settings.
Antibiotic use in early life is associated with autoimmune diseases like Type 1 diabetes (T1D), but evidence is inconsistent. We examined associations of prenatal and early-childhood (0-5 years) antibiotic use and T1D in New Zealand, a country with high antibiotic consumption. Using linked data, we identified antibiotic use during pregnancy and the first 5 years for all children born between 2005 and 2010 (n = 315,789), followed until 2021. Associations were assessed using Cox proportional hazard regression, adjusted for parental and perinatal factors. For prenatal exposure, we assessed associations with T1D-diagnosis from birth; for early-childhood exposure, associations were assessed with T1D-diagnosis from age 5. Antibiotic use (>= 1 course) was 29.2% for pregnant mothers and 96.3% for children aged 0-5 years. T1D was diagnosed in 0.36% (n = 1,131), with 0.28% (n = 906) diagnosed after age 5 years. Antibiotic use during pregnancy was associated with T1D, both expressed as a continuous variable (HR 1.05, 95% CI 1.03-1.08) and as a dichotomous variable (0 vs >= 1 course; HR 1.20, 1.05-1.38). When categorised into 0, <= 1, <= 2, and >= 3 courses, a significant (p = 0.0008) positive trend was observed. For postnatal exposure, the HR was 1.02 (1.02-1.03) and 1.62 (1.00-2.63), respectively; when categorised into 0, <= 4, <= 7, <= 12, and >= 13 courses, a significant dose-response trend (p = 0.0017) was shown. Strongest associations were found for moderate and broad-spectrum antibiotics in both periods. Prenatal penicillin and cephalosporins/cephamycins-use, and postnatal exposure to all antibiotic classes except tetracyclines were associated with a higher risk of T1D. In conclusion, antibiotic use during both prenatal and early childhood is associated with an increased risk of T1D.
Background: Type 2 diabetes (T2D) is a growing health concern among adolescents, driven by rising obesity rates. Early identification of prediabetes, particularly impaired fasting glucose (IFG), can guide interventions to reduce long-term risks. Despite the global burden of diabetes, limited data exist on Saudi adolescents, a population experiencing high rates of obesity. Objective: To determine the prevalence and associated factors for IFG in a representative sample of Saudi adolescents. Methods: We conducted a cross-sectional analysis on a subgroup of participants from the national Jeeluna study (2011-2012), which sampled adolescents aged 10-19 years from all 13 regions of Saudi Arabia. Anthropometric measurements, fasting plasma glucose levels, and lifestyle data were collected. Dysglycemia (IFG or diabetes) was defined using American Diabetes Association (ADA) criteria. A logistic regression analysis was conducted to identify factors associated with dysglycemia. Results: The study included 5,421 participants (50.8% females; mean +/- SD age was 15.9 +/- 1.8 years). Prevalence of dysglycemia was 4.8% (IFG: 4.1%; diabetes: 0.7%). Dysglycemia was more prevalent in obese adolescents (8.2%) compared to overweight (4.8%) and nonobese/nonoverweight peers (4.1%), p < 0.0001. Regional differences were noted with the highest prevalence in Mecca (6.1%). Compared with nondysglycemic patients, those who were dysglycemic had higher proportion of individuals consuming fast food meals per week (p = 0.03), body mass index (BMI) (p < 0.0001), tri-ponderal mass (TMI) (p < 0.001), waist-to-height ratio (p = 0.001) and systolic BP (p < 0.001) and lower triglycerides (p < 0.0001). Factors independently associated with dysglycemia included systolic BP (OR = 1.03; 95% CI 1.01-1.04, p < 0.0001), triglyceride levels (OR = 1.60; 95% CI 1.27-2.00, p < 0.0001) and geographical region (Mecca OR = 1.54, 95% CI 1.07-196, Riyadh OR = 0.61,95% CI 0.42-0.89, p < 0.001, compared with other regions combinedly). Conclusion: Our study highlights the prevalence of dysglycemia (4.8%) among Saudi adolescents, particularly in those with obesity. Risk factors included higher BMI and increased fast food consumption. Notably, regional differences were observed, with Mecca reporting the highest prevalence. Our findings underscore the need for targeted interventions in obesity, focusing on promoting healthy lifestyles and early screening for T2D in this vulnerable population.
Introduction:Optimal glycaemic control in adolescents with type 1 diabetes (T1D) is essential to prevent complications but remains challenging due to changing lifestyle behaviours. Objective:This pilot study aims to assess whether adolescents with T1D in Ireland meet current nutrition and physical activity (PA) guidelines and to explore the impact of nutrition and PA on glycaemic variability (GV). Methods:Seven adolescents with T1D recorded their PA, diet and blood glucose levels over seven consecutive days. GV was determined using continuous glucose monitoring (CGM) data. Results:The majority of participants demonstrated low levels of PA, with 72% falling below recommended levels, and 86% consuming excessive amounts of saturated fat. Blood glucose levels were in the very high and high ranges for 23.6% ± 25.2% and 22.6% ± 7.3% of the time, respectively, with only 52.6% ± 21.8% of the time spent within the target range. Although no significant associations were found between PA or nutrition and GV, participants who met or exceeded PA and protein guidelines and consumed less fat exhibited better GV parameters. Conclusion:Adolescents with T1D in Ireland are not meeting recommended PA and nutrition guidelines and show poor glycaemic control. As a pilot study, the small sample size limited statistical power, but observed trends suggest that adhering to lifestyle recommendations could improve glycaemic control in this population.
In this real-world analysis, we evaluated glycemia and insulin delivery in Italian children using the MiniMed 780G system during auto mode use, comparing days with a school routine to out-of-school (OOS) days. Data from 1341 users, self-reported under 16 years old and with type 1 diabetes (T1D), showed no meaningful difference in time in range (TIR) between school days (73.4%) and OOS days (72.4%), and international targets were met on average during both types of day. Minor sensor glucose variations were observed during school hours, such as a more pronounced glucose peak after breakfast and a clearer dip before lunch on school days. The insulin delivery algorithm effectively managed these fluctuations. Maintaining optimized glycemia during both school and OOS days may enhance learning and support cognitive and brain development.
Background:The rates of obesity and type 1 diabetes (T1D) in children and adolescents are increasing in many settings worldwide, but data on weight gain in this group are limited in New Zealand. We examined temporal body mass index (BMI) changes and associated factors in young people with T1D in a mixed urban-rural region. Methods:This study was a 20-year retrospective audit of clinical data from a regional paediatric diabetes service (June 2000-March 2021). The primary outcome was BMI standard deviation score (BMI SDS), whose trajectories from diagnosis were examined in association with demographic and clinical factors. Results:A total of 106 young people with T1D (56% male) were followed for a median of 8.3 years [Q1 = 6.1, Q3 = 11.0; maximum 15.1 years] and attended a median of 21 multidisciplinary clinic visits [Q1 = 12, Q3 = 30; range 1-56 visits]. In females, age at diagnosis modified the association between diabetes duration and BMI SDS (interaction p = 0.0009). Girls diagnosed at 4.0 years (age at diagnosis 25th percentile for girls in our cohort) had no statistically significant change in BMI SDS over the first 5 years after diagnosis [-0.13 SDS (95% confidence interval [CI] -0.32 to 0.06); p = 0.18], while those diagnosed at 9.5 years (75th percentile) experienced an increase of ≈0.39 SDS (0.08-0.70; p = 0.014). Among males, increasing age at diagnosis was associated with lower BMI SDS (p < 0.0001), whereas there was no statistically significant association with diabetes duration (p = 0.087). At any given duration, boys diagnosed at 11.1 years (age at diagnosis 75th percentile for boys) had a BMI SDS approximately 0.70 lower (95% CI -1.02 to -0.45; p < 0.0001) than those diagnosed at 4.7 years (25th percentile). Conclusions:We observed sex-specific BMI trajectories in young people with T1D, with age at diagnosis exerting variable influences on BMI SDS trajectory in boys and girls. These findings support individualised T1D management strategies within multidisciplinary care.
The upward trajectory of childhood and adolescent type 2 diabetes (T2D; youth-onset T2D) is a global health issue, disproportionately affecting non-white, ethnically diverse, and socioeconomically disadvantaged subgroups. Youth-onset T2D displays a more aggressive phenotype, with faster disease progression and earlier onset of severe complications when compared to adult-onset T2D. Despite this, the therapeutic options for the management of youth-onset T2D have historically been limited. Over the last few years, multiple new therapies across a range of drug classes, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, have been approved for use in youth-onset T2D. Despite this, patient recruitment to pediatric and adolescent trials remains a major challenge in youth-onset T2D, and there is currently a lack of large-scale, long-term clinical evidence for new treatment classes in this patient population. In this review, we provide an overview of the current treatment landscape in youth-onset T2D and summarize the available clinical data for SGLT-2 inhibitors in patients with youth-onset T2D, based on a targeted literature search.
IntroductionType 1 diabetes (T1D) may negatively impact cognitive function in children and adolescents, but data regarding its impact on academic performance remains inconsistent.AimTo systematically review the evidence on academic performance assessed by school grades in youth with T1D and its association with glycemic control.MethodsPubMed, Scopus, Web of Science, and Google Scholar were searched for studies evaluating academic achievement through school grades in children and adolescents with T1D and assessing its association with glycemic control. Risk of bias was evaluated using the Joanna Briggs Institute critical appraisal tool.ResultsSixteen studies involving 26,794 children and adolescents with T1D met the inclusion criteria. Thirteen studies were rated as having a low risk of bias. Of 11 studies comparing school grades of children with T1D to that of peers or national norms, five reported lower performance in youth with T1D, five reported no significant differences, and one found reduced performance in primary but not secondary school. Among 10 studies examining glycemic control, eight reported that higher HbA1c levels were significantly associated with lower school grades.ConclusionAcademic performance based on school grades in youth with T1D shows mixed results; however, poor glycemic control is consistently associated with reduced academic achievement. These findings underscore the importance of optimal diabetes management and highlight the need for longitudinal research to clarify causal relationships and inform interventions.
Background:Type 1 diabetes (T1D) incidence is rising globally, with significant regional variation. Data from highly homogeneous populations, such as Lithuanian, may contribute to a better understanding of contributing T1D factors. This study examines 24-year trends in childhood T1D incidence and seasonal patterns in Lithuania. Methods:The annual incidence rates (IRs) were computed utilizing established methodologies per 100,000 children <15 years. The study included 2369 (1181 boys) patients with T1D. Results:During 2001-2024, the mean IR was 21.4 per 100,000 < 15 years (95% CI: 20.89, 27.28). The incidence rose from 10.8 to 36.4 per 100,000 children under 15 years of age, with notable peaks observed in 2021 and 2022, temporally aligning with the highest COVID-19 infection waves. Subgroup analysis showed the most rapid increase in young teenagers (10-14 years). Most new cases (63.5%) were diagnosed from September to March. Conclusions:This study demonstrates a rapidly increasing incidence of T1D in Lithuanian children over a 24-year period and is one of the highest in European countries. The seasonal distribution of new cases has been speculated to be due to reduced sunlight exposure and lower vitamin D levels, as well as increased school related stress and viral infections during autumn and winter months. However, additional contributing factors are likely involved, underscoring the need for further research.
Background:Chronic diseases such as type 1 diabetes mellitus (T1DM) may alter linear growth; however, reports regarding growth in children with T1DM have been inconsistent. This study aimed to investigate the height and growth velocity of patients with T1DM, and whether they were affected by various factors 5 years after the diagnosis. Methods:This retrospective study included patients with T1DM between October 2005 and May 2022, with a follow-up period of at least 1 year. Patients with diabetes, thyroid disease, celiac disease, or any other chronic disease were excluded. We compared the mean height standard deviation score (H-SDS) and growth velocity between groups divided based on glycosylated hemoglobin (HbA1c) levels and use of continuous glucose monitoring (CGM) systems. Results:Among the 150 patients, 45.3% were male, with a mean age at diagnosis of 7.8 ± 3.6 years. At diagnosis, the mean H-SDS was 0.38 ± 1.11. In males, H-SDS significantly decreased overtime, with an estimated slope (β) of -0.054 (standard error [SE] = 0.013, 95% confidence interval [CI]: -0.079 to -0.029, p < 0.01). The decline in H-SDS was more pronounced in the poorly-controlled group (mean HbA1c ≥7.0%) compared to the well-controlled group (mean HbA1c <7.0%; β = -0.081, SE = 0.016, 95% CI: -0.112 to -0.050 vs. β = -0.007, SE = 0.020, 95% CI: -0.047 to -0.033, p < 0.01). Among males using CGM, the decrease in H-SDS over the 5-year follow-up was significantly less than that observed in the non-CGM group (β = -0.012, SE = 0.023, 95% CI: -0.057 to -0.034 vs. β = -0.072, SE = 0.015, 95% CI: -0.101 to -0.042, p = 0.03). In the multivariable linear mixed model analysis, younger age at diagnosis (β = -0.009, 95% CI: -0.017 to -0.002, p = 0.02), female (β = 0.067, 95% CI: 0.033 to 0.100, p < 0.01) and lower HbA1c levels (β = -0.026, 95% CI: -0.038 to -0.015, p < 0.01) were significantly associated with greater improvement in H-SDS over 5 years. Conclusion:Glycemic control and CGM use positively affected linear growth in children with T1DM, especially in males. CGM use was associated with improved growth outcomes, which suggests that glucose monitoring may help mitigate the adverse effects of poor glycemic control on growth.
Objectives:The Tandem t:slim X2 insulin pump with the Control-IQ technology (Control-IQ) is an automated insulin delivery (AID) system for glycemic control but has limited data in Saudi pediatric and young adult populations. We aim to evaluate the efficacy and safety of Control-IQ therapy in children with insulin-dependent diabetes and previously treated with multiple daily injections (MDIs). The primary outcome is to assess the change in HbA1c 6 months after initiating Control-IQ technology. Methods:This prospective observational study evaluated children aged 2-14 years with insulin-dependent diabetes who transitioned from treatment with MDI to the Control-IQ technology in the diabetes clinic at the King Faisal Specialist Hospital and Research Centre (KFSHRC) in Saudi Arabia. Results:A total of 100 patients (44 boys and 56 girls; median age was 11 years) were included. Most (82%) had a history of severe hypoglycemia. Following Control-IQ initiation, median HbA1c significantly decreased from 9.2% to 6.9% at 6 months (-25.0%; p < 0.001), accompanied by a 24.4% reduction in the daily insulin dose. Time in range (TIR) (70-180 mg/dL) improved from 45.6% to 68.8% (+23.2%; p < 0.001), while time in significant hypoglycemia (<54 mg/dL) decreased by 88.9% (p < 0.001). At 6 months, 83% achieved ≥60% TIR, and 54% reached ≥70%. Adherence and engagement were high, with no severe hypoglycemia or discontinuations. Only 3% experienced mild/moderate ketoacidosis due to technical issues in the Control-IQ. Conclusions:The findings demonstrated that Control-IQ technology is both effective and safe in improving glycemic outcomes in children with insulin-dependent diabetes in a real-world clinical setting. However, successful implementation requires comprehensive training and continuous support.
Background:Diabetes distress is prevalent among youth with type 1 diabetes mellitus (T1DM) and can negatively impact their quality of life and metabolic control. Identifying modifiable factors to reduce this distress is crucial. This study investigates the interplay between diabetes distress, self-management, and quality of life in school-aged children with T1DM amidst the COVID-19 pandemic. Its primary objective is to identify modifiable factors that can assist these children as they navigate the challenges associated with transitioning into adolescence. Methods:A cross-sectional study with data from 341 Chinese school-age children aged 8-12 was conducted. Data were collected through an online self-report survey during the COVID-19 pandemic (June-December 2022). The data included sociodemographic and clinical characteristics, diabetes distress, diabetes care activities and diabetes problem solving of diabetes self-management and quality of life. Structural equation modeling assessed relationships and mediation effects. Results:All four domains of diabetes distress exhibited negative associations with quality of life (r = -0.74 to -0.77, p < 0.01). Care activities and problem-solving related to diabetes self-management mediated the associations of emotional burden and regimen-related distress with quality of life (both p < 0.05). Conversely, neither diabetes care activities nor diabetes problem-solving mediated the relationship between physician-related distress and quality of life. Conclusions:Our findings indicate that problem-solving techniques related to diabetes self-management might be more effective at alleviating various aspects of diabetes distress-such as emotional burden, regimen-related distress, and interpersonal distress-compared to diabetes care activities. Interventions that teach structured problem-solving strategies could be beneficial. Given the ongoing pandemic, these findings could also serve as useful guidance for developing support strategies for school-age children with chronic conditions during future public health emergencies.
Background:Celiac disease (CD) occurs in ~6% of individuals with type 1 diabetes (T1D) and may complicate glycemic control due to conflicting dietary needs. Prior studies show mixed results regarding the impact of CD on Hemoglobin A1c (HbA1c), especially in pediatric populations. This study evaluates whether CD is associated with suboptimal glycemic control in pediatric patients with T1D. Methods:This retrospective chart review analyzed pediatric patients (<18 years) diagnosed with T1D between 2012 and 2023 across Corewell Health East. Patients were identified via ICD-10 codes and stratified by CD status and glycemic control (controlled HbA1c <7% vs. uncontrolled HbA1c ≥7%). Statistical analyses include chi-square or Fisher's exact tests for categorical variables, Wilcoxon tests for continuous variables, and logistic regression for multivariable analysis. Results:Among 2,203 pediatric patients with T1D, 101 (4.6%) had CD. Patients with both conditions were younger at T1D diagnosis (median age 9 vs. 12 years, p < 0.0001) and had more HbA1c measurements. A higher proportion of CD patients had uncontrolled diabetes (89.1% vs. 73.8%, p = 0.0006). CD was independently associated with uncontrolled HbA1c (adjusted OR: 2.59; 95% CI: 1.37-4.90; p = 0.003) after adjusting for age, sex, and race. Younger age and Black race were also associated with higher odds of uncontrolled diabetes. Conclusion:CD is significantly associated with poorer glycemic control in pediatric patients with T1D, independent of age, race, and sex. These findings suggest the need for closer monitoring, individualized dietary counseling, and targeted interventions in this high-risk group.
Aims: Is the current screening for early-stage type 1 diabetes (T1D) associated with the rate of diabetic ketoacidosis (DKA) at T1D manifestation at population level? Materials and Methods: Children with T1D manifestation in 2015-2023 in Germany, aged 0.5 to <15 years from the multicenter diabetes registry (DPV) were included and allocated to federal states (FSs) based on their residential postal code. The relative risk (RR) with 95% confidence interval for DKA at manifestation of T1D by FS with vs. without screening, and demographic/context factors was calculated using logistic regression models. Results: 24,408 children (54.3% males) were included with median onset age of 8.8 (quartiles: 5.3; 11.8) years. The RR for DKA was not significantly lower in FS with vs. without screening (RR: 0.96 [0.93-1.03], p = 0.393) overall, but in the sub-group of children with the highest probability of being screened (age 1.75-10.99 years, manifestation in Bavaria from 2020 to 2023, RR: 0.88 [0.80-0.97], p = 0.012). The most important predictor for DKA was manifestation age <3 years (RR: 1.83, [1.66-2.03], p < 0.001). Conclusions: Until 2023, current regional screening initiatives for early-stage T1D were not associated with lower frequency of DKA at population level, but might be helpful in the future if the coverage can be markedly increased.
Introduction:Type 1 diabetes mellitus (T1DM) is an autoimmune disease that damages insulin-producing pancreatic cells, often appearing in childhood. Global incidence is rising at 2%-3% yearly. Its exact cause is unclear. Prenatal exposures and maternal autoimmune disorders have been reported as potential risk factors. This study aimed to explore how maternal autoimmune conditions might correlate with the onset of T1DM, employing a population-focused approach. Methods:This is a retrospective population-based cohort study with a nested case-control analysis. Primary data were derived from the Maternal and Child Health Database (MCHD) and the National Health Insurance Research Database (NHIRD). This study enrolled a total of 2,036,051 newborns born between 2004 and 2014. They were followed up until the end of 2020. A total of 1273 children under the age of 17 with T1DM were identified from 2004 to 2020. A 1:10 control group, matched by birth date and sex, was selected for comparison. T1DM patients were identified through the Catastrophic Illness Registry Database. Maternal autoimmune diseases were determined using the primary diagnosis codes for hospitalizations and outpatients' visits. Results:After adjusting for cofactors, the offspring of mothers with an autoimmune disease had a higher risk of T1DM (adjusted odds ratio [aOR] 1.95, 95% confidence interval [CI]: 1.45-2.63, p < 0.001). For individual autoimmune diseases, T1DM (aOR: 6.81, 95% CI: 2.30-20.16, p < 0.001), Hashimoto thyroiditis (aOR: 3.75, 95% CI: 1.85-7.60, p < 0.001), rheumatoid arthritis (aOR: 2.49, 95% CI: 1.08-5.77, p = 0.033), and Graves' disease (aOR: 1.85, 95% CI: 1.14-2.99, p = 0.013) significantly increase the risk of developing T1DM in their children. Conclusions:Offspring of mothers diagnosed with autoimmune disease, notably T1DM, autoimmune thyroiditis, and rheumatoid arthritis, may indeed have a heightened likelihood of developing T1DM. These findings underscore the importance of targeted screening programs for T1DM in children of affected mothers.
Cystic fibrosis-related diabetes (CFRD) is the most prevalent nonrespiratory complication of cystic fibrosis (CF), with its prominence growing as survival rates improve due to advances in CFTR modulator therapies. Its prevalence increases with age, affecting nearly 50% of patients with CF (PwCF) over 30 years old. CFRD primarily results from progressive pancreatic fibrosis leading to insulin deficiency, further compounded by intermittent insulin resistance during pulmonary exacerbations and systemic inflammation. Key risk factors include pancreatic insufficiency, female sex, severe CFTR genotypes (such as p.F508del homozygosity), CF-related liver disease, and family history of type 2 diabetes. The early stages of CFRD are often asymptomatic, necessitating proactive screening. Annual oral glucose tolerance tests (OGTT) beginning at age 10 are challenging to perform but remain the gold standard for early detection, while continuous glucose monitoring (CGM) is increasingly recognized as a valuable complementary tool. Diagnosis is based on standard OGTT criteria, with indeterminate glycemia (INDET) and impaired glucose tolerance (IGT) recognized as prediabetic stages requiring close monitoring. Even early abnormalities in glucose metabolism may be associated with declines in pulmonary function and nutritional status, underscoring the need for rigorous surveillance and timely therapeutic intervention. Early initiation of insulin treatment can substantially mitigate these complications and improve clinical outcomes. Insulin remains the cornerstone of CFRD management, is recommended as the primary treatment for patients with CFRD (PwCFRD) rather than dietary modification alone. While pilot studies and observational cohorts have suggested potential benefits of early insulin treatment in individuals with early glycemic abnormalities such as INDET or IGT, findings from randomized controlled trials do not provide evidence to justify initiating insulin before CFRD is established. Management strategies should be individualized, with personalized glycemic targets. Insulin dosing aims to achieve the maximum tolerable dose to maintain a low HbA1c, control postprandial hyperglycemia without inducing hypoglycemia, minimize catabolism, and preserve optimal nutrition and pulmonary health without restricting carbohydrate intake. Regular glucose monitoring, quarterly HbA1c measurements, and annual screening for microvascular complications starting 5 years after diagnosis are essential to optimize outcomes. The advent of CFTR modulator therapies has revolutionized CF care, significantly improving outcomes and quality of life for PwCF. These therapies also show promise in improving glucose regulation and may impact the prevalence, onset, and course of CFRD. However, current data remain inconclusive, and the long-term effects are still being elucidated. Future directions in CFRD research include refining screening protocols, exploring adjunctive noninsulin therapies, and developing predictive biomarkers. This review summarizes the current understanding of CFRD pathophysiology, diagnosis, and management strategies, emphasizing the importance of early intervention and personalized care in the context of evolving CF treatment approaches and their potential to improve prognosis for PwCF.
