The Impact of Cystic Fibrosis‐Related Diabetes on Barriers to Self‐Management

BACKGROUND: Cystic fibrosis (CF) is a complex disease requiring adherence to an intensive medical regimen to maintain health. For those who develop CF-related diabetes (CFRD, 20% adolescents, 30%-50% adults), daily self-management is additionally complex and burdensome. This study aimed to examine how managing CFRD influences self-efficacy, adherence, mental health, and executive functioning for people with CF. METHODS: Using data collected in a cross-sectional study addressing barriers to daily care, we examined relationships between self-efficacy (CF-Medication Beliefs Questionnaire), adherence measures (composite medication possession ratio), barriers to daily care (Daily Care Check-in), psychological outcomes (Patient Health Questionnaire-8 and General Anxiety Disorder Scale-7), and executive function (Behavior Rating Inventory of Executive Function), comparing those with and without CFRD. RESULTS: Of 405 participants enrolled, 131 (33%) had CFRD. Treatment complexity was higher for those with CFRD (p < 0.001), but adherence, barriers to daily care, anxiety, depression, and executive function did not differ by CFRD status (p > 0.05 for all). People with CFRD had higher self-efficacy (p = 0.030) and lower concerns about privacy (p = 0.015) than those without CFRD. CONCLUSIONS: 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. No differences were seen in mental health or executive function variables. Future research is needed to further explore relationships between executive function, glycemic outcomes, and diabetes management in samples representative of the population with CF and CFRD.