UAB - Center for Clinical and Translational Science

1. Diagnosis of Cystic Fibrosis Related Diabetes (CFRD) 2. Age 21-75 years at time of consent 3. BMI 19-50 kg/m2 (In Asians BMI is ~ 2 points lower for comparison so it is 17-48 kg/m2) 4. Creatinine ≤ 1.4 mg/dl in women and ≤ 1.5 mg/dl in men 5. HbA1c ≤ 11% lifestyle treatment or mono/combination therapy with oral hypoglycemic agents (e.g. metformin or sulphonylurea or SGLT2i) and preferably on insulin pump therapy (i.e., SAP, HCL) with or without CGM will be recruited. However, use of MDI (Multiple Daily Injections) of insulin, i.e., on basal-bolus insulin therapy will also be included. Most of our patients are on insulin therapy with very few on oral antidiabetes medications but we would like to offer them the choice of participation. 6. Subjects on FDA approved/recommended full doses of ETI will be offered participation. If dose adjustments of ETI are made after enrollment a discussion will be done with the primary care provider and HCSTOC as required. 7. Willing to be at a stable weight for duration of the study. 8. An understanding of and willingness to follow the protocol and sign the informed consent Subjects meeting any of the

at baseline will be excluded from study participation: Exclusion Criteria: 1. Debilitating chronic disease 2. Anemia <10.0 gm/dL in females and <11.0 gm/dL in males 3. Symptoms of undiagnosed illness on history/exam 4. Abuse of alcohol or recreational drugs 5. Pregnancy 6. Active hepatic disease (we will include only if less than 3X ULN for liver enzymes and no fibrosis on ultrasound). Transient elevations of liver enzymes will not exclude participation but will be discussed with the primary care provider and HCSTOC as required. 7. Current use of the following drugs and supplements: i. Corticosteroids ii. Benzodiazepines iii. Opiates iv. Barbiturates v. Anticoagulant therapy vi. Any other medication that the investigator believes is a contraindication to the subject's participation