Leveraging the large patient population with cystic fibrosis (CF) cared for by the MGH CF Center, the goal of this research program is to improve our understanding and treatment of CF-related diabetes (CFRD). CF is a life-shortening disease that causes progressive respiratory decline. People with CF are also at high risk of developing CFRD, which not only worsens their health but also adds substantial treatment burden and compromised quality of life. Our research has investigated diabetes technologies in CF to (1) overturn age-old teachings on the accuracy of glycemic measures, (2) improve approaches to screening and diagnosis, (3) redefine nutrition and how we measure it, (4) explore the safety and efficacy of novel insulin delivery devices in this unique form of diabetes, and (5) improve access for patients to these technologies. This program has also supported the career development of multiple fellows and junior investigators who have gone on to successful careers in academic medicine and industry, and a key focus of our research group is providing mentorship in diabetes research.

With funding from the NIDDK and the Cystic Fibrosis Foundation (CFF), we are currently investigating the application of diabetes technology to the screening, diagnosis, and treatment of CFRD as well as the impact of nutrition on glycemic control and clinical outcomes. Utilizing resources from the clinical research core led by Dr. Nathan, we recently completed a clinical study investigating the use of continuous glucose monitoring (CGM) in the diagnosis of CFRD, finding that average glucose derived from CGM correlates well with A1c. We are also exploring the use of continuous glucose monitoring to the screening and diagnosis of CFRD. Funded by the NIDDK and Cystic Fibrosis Foundation, we are leading a multicenter randomized clinical trial investigating the safety and efficacy of artificial pancreas technology (the iLet bionic pancreas) in children and adults with CFRD. We are also leading the Maternal and Fetal Outcomes in the Era of Modulators (MAYFLOWERS) CGM substudy, collecting comprehensive CGM data in pregnant women with CF throughout pregnancy at 30 CF Centers across the US, as well as the Strength and Muscle Related Outcomes for Nutrition and Lung Function in CF (STRONG-CF) investigating innovative measures of nutrition and sarcopenia in adults with CF at 25 CF Centers.

In addition to our focus on CFRD, we have also expanded our investigations to include other vulnerable and understudied diabetes populations, including pregnant women, those with insulin-requiring type 2 diabetes, and people with diabetes in rural regions who lack access to endocrinologists. In collaboration with BADERC investigator Dr. Camille Powe, we are planning clinical trials to adapt and investigate the safety and efficacy of the iLet bionic pancreas for the management of T1D and T2D during pregnancy, when tighter glycemic targets and dynamic insulin needs make management particularly challenging and high stakes. In addition, in collaboration with investigators in Family Medicine at the University of Colorado, we successfully completed a preliminary random-order clinical trial in 40 adults with T1D showing that the iLet bionic pancreas can be successfully deployed over telehealth in the primary care setting, and we now have funding from the Helmsley Charitable Trust to expand to a large multi-state randomized clinical trial enrolling people with type 1 and type 2 diabetes via telehealth in rural areas without endocrinology access, bringing this technology to under-served populations. We hope these studies will revolutionize how we care for our highest risk diabetes patients.