Improving Screening for Cystic Fibrosis–Related Diabetes at a Pediatric Cystic Fibrosis Program

Abstract

OBJECTIVE: Despite guidelines recommending an annual oral glucose tolerance test (OGTT) for all patients with cystic fibrosis (CF) aged $10 years, screening rates for cystic fibrosis-related diabetes (CFRD) remained low at our center. The aim of this project was to implement an outpatient system to provide effective, evidence-based screening for CFRD at a pediatric CF program.METHODS: Development of a system to improve outpatient screening for CFRD included structured education, communication with families, and processes for scheduling laboratory appointments. The primary outcome measure was the proportion of eligible patients seen at the clinic who received an OGTT by the subsequent clinic appointment. The proportion of patients without CFRD in our program who received an OGTT within the previous 12 months was also tracked longitudinally. RESULTS:The outpatient screening rate for CFRD increased from 2% of eligible patients seen at the clinic during the 18 weeks before the start of our initiative to 78% during the 18 weeks after the start of our initiative (P , .001). The screening rate was also increased from the corresponding date range the previous year, when only 35% of eligible patients received an OGTT (P , .001). The overall percentage of patients without CFRD in our program who received an OGTT in the previous 12 months increased from 47% to 71% after implementation of our initiative (P = .003). CONCLUSIONS:A systematic, quality improvement approach effectively increased the rate of outpatient screening for CFRD at a pediatric CF program. Pediatrics 2013;132:e512-e518 AUTHORS:

Peak glucose during an oral glucose tolerance test is associated with future diabetes risk in adults with cystic fibrosis

“…The advantage is the potential to improve the sensitivity of this clinical test; the limitations are in cost and more intensive testing for patients and healthcare teams. Adherence to OGTT screening is already <50% at many centres [2,25,28,33], mainly due to perceived burden from both sides [19]. We found that a five time point OGTT provided better assessment of CFRD risk but its applicability in a clinical setting needs to be established.…”

Standards of Medical Care in Diabetes—2014

“…Genetically determined function of the remaining b-cells and insulin resistance associated with infection and inflammation may also play a role. Encouraging data suggest that improved screening (544,545) and aggressive insulin therapy have narrowed the gap in mortality between cystic fibrosis patients with and without diabetes, and have eliminated the sex difference in mortality (546). Recent trials comparing insulin with oral repaglinide showed no significant difference between the groups.…”

Cystic fibrosis-related diabetes: Prevalence, screening, and diagnosis

“…The OGTT is a time-consuming test requiring overnight fasting, hence overall screening rates remain low in the US. There are several patient barriers associated with low screening rates including need for prolonged fasting, separate and long appointment times, and insufficient awareness about the importance of screening [27] , [28] .…”