**6.1. Microvascular complications**

Microvascular complications may develop in CFRD leading to the typical associated pathol‐ ogies (retinopathy, nephropathy and neuropathy), any of which may significantly impact the on-going management of the condition, particularly the development of visual impairment, gastroparesis and renal failure.

Where glucose control has deteriorated to the point that fasting hyperglycaemia is present (a relatively rare occurrence in the CFRD population), a significant proportion will also have developed retinopathy and microalbuminaemia (16% and 14%, respectively) [61]. Almost half of all CFRD patients will display some degree of neuropathy, in most cases where the dys‐ glycaemia has been present for over a decade [43].

Examples of autonomic dysfunction and gastroparesis have been reported [61], although the latter condition may be difficult to differentiate from the delayed gastric emptying that occurs in up to 50% of the CF population regardless of their glucose tolerance [43].

Overall, the prevalence of microvascular complications is less in CFRD than in other forms of diabetes, possibly due to the partially preserved endogenous insulin production and sensi‐ tivity leading to relatively short periods of hyperglycaemia.

### **6.2. Macrovascular complications**

Although there is nothing to suggest dysglycaemia is not a significant risk factor for the development of macrovascular complications in individuals with CF, as it is in other popula‐ tions, at present their occurrence very infrequently complicates the management of CFRD.

Although there are case reports of both coronary artery disease and strokes occurring in diabetic CF patients [62, 63], there is at present no evidence of excess mortality attributable to cardiovascular or cerebrovascular disease despite these patients often having co-existing dyslipidaemia.

Currently, the consequences of significant dysglycaemia are likely to manifest earlier and more profoundly in other ways, e.g. deteriorating lung function, but as the life expectancy of the general CF population continues to rise there is likely to be both a concurrent increase in the incidence of CFRD and ultimately macrovascular complications.
