CFRD patients successfully manage high treatment burden: Study
Diabetes doesn't lead to worse treatment adherence, mental health
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CF-related diabetes (CFRD) patients are able to adhere to their treatment routines, and the condition doesn’t hurt their mental health or cognitive functioning despite posing a greater treatment burden than cystic fibrosis (CF) alone, a U.S. study found.
In an analysis of almost 400 participants, people with CFRD had higher self-efficacy scores, indicating they believed they could complete self-care tasks and manage their condition, than those with CF alone. There were no significant differences between the two groups in measures of depression, anxiety, or executive function (goal-oriented behaviors such as planning, organization, and problem-solving).
CFRD patients “were able to maintain similar pulmonary medication adherence despite higher treatment complexity, which could be related to their greater self‐efficacy,” the researchers wrote.
The study, “The Impact of Cystic Fibrosis-Related Diabetes on Barriers to Self-Management,” was published in Pediatric Pulmonology.
CF is caused by genetic mutations that result in the loss or dysfunction of the CFTR protein, leading to the accumulation of thick, sticky mucus in various organs, including the lungs and digestive system. Mucus buildup in digestive organs, including the pancreas and intestines, may interfere with normal digestion and lead to CFRD.
Diabetes poses added treatment burden
In CFRD, damage to the pancreas leads to insufficient production of insulin, the hormone that helps cells absorb glucose from the blood so they can use it for energy. People with CF are also often insulin-resistant, meaning their tissues don’t respond to the hormone normally.
CF management requires adherence to an intensive treatment regimen. Additional burdens for those who develop CFRD include taking insulin and monitoring blood sugar and nutritional intake.
“We hypothesized that those with CFRD would have lower self-efficacy, lower pulmonary medication adherence, more barriers to self-management, higher rates of depression and anxiety, and higher rates of executive functioning challenges,” the investigators wrote.
The study is a secondary analysis of the Daily Care Check‐In (DCC) Validation study, conducted at multiple CF care centers in the CF Foundation’s Success with Therapies Research Consortium.
A total of 398 participants, 131 with CFRD (33%) and 267 with CF but not CFRD, took part in the study. Those with CFRD were significantly older (26.9 vs. 23.8), had worse lung function (mean percent predicted forced expiratory volume in one second 64.9% vs. 79.3%), and more frequently had pancreatic insufficiency (98.5% vs. 89.5%) and required into-the vein antibiotics in the previous year (68.7% vs. 42.9%) than those without CFRD.
Participants completed the CF-Medication Beliefs Questionnaire, which assesses health behaviors and self-efficacy. Researchers analyzed treatment adherence, perceived barriers to treatment adherence, and treatment complexity using specific tools. Treatment complexity was assessed using the Treatment Complexity Score, a composite measure of the overall burden of prescribed therapies for CF, including pulmonary medications and CFTR modulators.
Results showed that people with CFRD had significantly higher treatment complexity (19.1 vs. 15.2) and a higher general self-efficacy score (7.5 vs. 7.0). They also reported fewer concerns about privacy, in the sense of being able to handle health-related tasks in the presence of others, than those without diabetes.
No differences between the two patient groups were found in adherence to pulmonary medication or in barriers to treatment adherence.
The findings show that “despite higher treatment complexity, people with CFRD had similar adherence and higher self‐efficacy than those without CFRD, suggesting that, in our sample, managing CFRD may uniquely impact self-efficacy, supporting adherence by way of adaptive coping,” the researchers wrote.
Regarding mental health issues, 15.9 % of those with CFRD and 11.9% without the condition reported moderate to severe signs of depression. Similar percentages had signs of moderate to severe anxiety. There were no significant differences between the groups.
Executive function was assessed using the self-reported Behavior Rating Inventory of Executive Function. Results suggested that having CFRD was not associated with significantly different executive function, including behavioral, cognitive, and emotional regulation scores, compared with CF patients without CFRD, both in adolescents and adults. In fact, executive function scores remained within the normal range of the general population.
“Future research is needed to further explore relationships between executive function, [blood sugar] outcomes, and diabetes management in samples representative of the population with CF and CFRD,” the team wrote.
The researchers said a “notable limitation” of their study was “the inability to examine diabetes-specific outcomes, specifically including blood sugar fluctuations and adherence to the diabetes regimen.”
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