Evaluating continuous glucose monitoring and metabolic profiles in adults with Cystic Fibrosis Related Diabetes (CFRD).

This will be a single-centre, open-label prospective, randomized crossover trial with an embedded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) evaluation framework. The trial will randomize eligible participants with confirmed cystic fibrosis (CF)-related diabetes on insulin to compare continuous glucose monitoring (CGM) with the Freestyle Libre 2 system with standard care (fingerstick blood glucose monitoring) with cross over at 3-months. The Freestyle libre 2 continuous glucose monitoring device (Abbott Diabetes) is approved for use in people with diabetes on insulin and forms part of standard clinical care for all people above 4 years of age living with type 1 diabetes in Australia. This device will be used according to manufacturer instructions in adults with confirmed cystic fibrosis related diabetes and compared to fingerstick blood glucose monitoring. The CGM consists of a sensor and reader. The sensor is encompassed within a sterile application device that is designed to be inserted independently by the person wearing the CGM. The sensor (size of a 20-cent coin) is applied to the back of the upper arm and involves the insertion of a thin, flexible, sterile fibre (5mm long) into the subcutaneous tissue where it remains in-situ for 14 days. The reader is an application that can be downloaded onto a Smartphone which enables it to function as a reader when scanned over the sensor. The Freestyle Libre 2 system records an interstitial glucose reading every 10-15 minutes. The sensor system is kept in place by an adhesive. This CGM system has been validated for use in people with CF. Sensor usage metrics will be used to provide information on engagement of the individual wearing CGM with the system. CGM onboarding will be provided by a credentialed diabetes educator using face-to-face and/or online educational resources. There will be no washout period.