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The limited available evidence supports the use of insulin treatment in CFRD. This fits with the dominant problem in CFRD being insulin deficiency and progressive beta cell dysfunction, making tablets that stimulate the beta cell unlikely to be a successful strategy. It is possible that patients with IGT or CFRD with moderate hyperglycaemia (e.g. relative preservation of fasting glucose) may initially respond to beta cell secretagogues. A large randomized prospective trial in the USA should answer this point in the next few years.