Improving screening in a Paediatric cohort for cystic fibrosis related
diabetes: a quality improvement project
Abstract
Background: There is considerable variation in recommendations
from clinical practice guidelines on when and how to screen for glucose
intolerance in people with cystic fibrosis (CF). In terms of glucose
tolerance, the Australian Standards of Care state that blood glucose
monitoring should be performed to exclude hyperglycaemia on a regular
basis. Annual oral glucose tolerance test (OGTT) in patients 10 years or
older should be considered and performed in patients with symptoms
suggestive of glucose impairment or unexplained weight loss, growth
failure or worsening respiratory disease. In 2018, 13 (14%) of the
eligible 99 patients with CF ≥10 years old had an OGTT. Aims:
To evaluate the added benefit of enhanced screening to children and
adolescents with CF by improving screening to 50% by the end of 2020.
Methods: A prospective cross-sectional quality
improvement cycles was performed on patients in the CF clinic, ≥11 years
for OGTT. Patients were excluded from OGTTs if they were prescribed
insulin or prolonged oral/parenteral steroids. Multiple quality
improvement initiatives were tried. Each intervention was done as a
plan-do-study-act cycles with refinement between each.
Results: Screening for CF related diabetes (CFRD)
increased in 2020 to 60% of >10 year olds. Four patients
had new results suggestive of CFRD and ten had new impaired glucose
tolerance. The most successful strategy was sending letters to
families. Conclusion: The Australian Standards of
Care may require revision, as there may be a benefit of routine
screening of all children at certain ages as opposed to waiting for
symptoms.