A provider survey of cystic fibrosis related diabetes screening and management practices at North American CF centers

Frontiers in Endocrinology

Endocrinology

Christine L. Chan¹  Tim Vigers¹  Katie Larson Ode²  Rebecca Hicks³ 

[1] Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;Department of Pediatrics, University of Iowa, Iowa City, IA, United States;Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, United States;University of California, Los Angeles, Division of Pediatric Endocrinology, Los Angeles, CA, United States;

关键词: cystic fibrosis;    diabetes screening;    CFRD;    oral glucose tolerance test;    glycemia;    continuous glucose monitor;   

DOI  :  10.3389/fendo.2023.1183288

 received in 2023-03-09, accepted in 2023-05-01,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundCystic Fibrosis Foundation (CFF) Guidelines recommend annual screening for cystic fibrosis related diabetes (CFRD) with an oral glucose tolerance test (OGTT). However, screening rates remain consistently low. We conducted surveys of 1) US CF center directors and 2) Endocrinologists affiliated with the CFF-sponsored EnVision program to characterize CFRD screening practices, describe provider perceived barriers to screening, and identify strategies for improving screening.MethodsThe surveys queried OGTT protocols, alternate screening strategies, and perceived barriers to screening. CF center characteristics and procedures for coordinating OGTTs were compared between centers achieving ≥50% versus <50% OGTT completion. Endocrinologists received additional questions regarding OGTT interpretation and management.ResultsThe survey response rate was 18% (51/290) from CF Centers and 63% (25/40) from Endocrinologists. The majority (57%) of CF centers utilized 2 OGTT timepoints (0,120 min). The majority (72%) of Endocrinologists utilized 3 timepoints (0,60,120 min). Four percent of CF centers and 8% of Endocrinologists utilized other timepoints. Forty-nine percent of CF centers reported ≥50% OGTT completion in the past year. Completion of ≥50% OGTT was 5 times more likely when patient reminders were consistently provided (p = 0.017). Both CF Centers and Endocrinologists employed alternative screening strategies including HbA1c (64%, 92%), fasting plasma glucose (49%, 67%), continuous glucose monitoring (30%, 58%), and home fingerstick monitoring (55%, 50%).DiscussionOGTT is the gold standard screening method for CFRD, but completion rates remain suboptimal, practice variation exists, and many providers utilize alternate screening strategies. Systematic reminders may improve completion rates. Studies to improve our approach to CFRD screening are urgently needed.

【 授权许可】

Unknown   
Copyright © 2023 Hicks, Ode, Vigers and Chan