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Clinical interventions in COPD
P86 The Screening and Diagnosis of Cystic Fibrosis-Related Diabetes in the United Kingdom
  1. KL Wickens-Mitchell1,
  2. FJ Gilchrist2,
  3. W Lenney1
  1. 1Keele University, Keele, UK
  2. 2University Hospital of North Stafforshire, Stoke on Trent, UK

Abstract

Introduction Cystic fibrosis related diabetes (CFRD) affects 17% of CF patients in the UK and is increasing in prevalence. It has a major detrimental impact on pulmonary function, nutritional status and survival; these effects are frequently seen prior to diagnosis. The UK CF Trust guidelines regarding CFRD screening, diagnosis and management differ from those used in Europe and the USA. We conducted a study to establish current UK clinical practise.

Methods A questionnaire was emailed to consultants at each of the 48 UK CF specialist centres. Data were gathered on the screening and diagnosis of CFRD as well as the personnel involved.

Results Completed questionnaires were returned by 39/48 centres (81%). Only 3/21 (14%) paediatric centres begin screening at 12 years (as per the UK CF Trust guidelines), with the majority; 11/21 (52%) starting to screen children at 10 years (as per the European and USA guidelines). Five centres start screening at a child’s first annual review. The most common test used to screen patients for CFRD is the oral glucose tolerance test (OGTT) which is used in 33/39 (85%) centres. However, this tool is only used in isolation by 3/33 (9%) centres. More commonly, results of the OGTT are combined with random blood glucose tests and/or HbA1C measurement. The test most frequently used to diagnose CFRD is home blood glucose monitoring which is undertaken in 32/39 centres (82%). Again this is rarely used in isolation, more commonly combined with HbA1C and/or with the results of a continuous glucose monitoring system (CGMS). CGMS is undertaken for diagnosis in 23/39 centres (59%). The decision to initiate insulin therapy was most often shared between a CF consultant and diabetologist. However, in 4/14 (36%) centres a diabetic nurse specialist had sole responsibility.

Conclusions In UK clinical practise the screening and diagnosis of CFRD is not uniform. Various methods are used and there is poor adherence to UK CF Trust guidelines. However, these guidelines from 2004 are somewhat out-dated and need to be updated to reflect the current best available evidence. This is likely to decrease the variation in practise.

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