Improving screening in a Paediatric cohort for cystic fibrosis related diabetes: a quality improvement project

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.