Figure 1 Quality improvement strategies over 2018-2020 to improve OGTT
screening. OGTT – oral glucose tolerance test (number of eligible
patients = 95).
The limitations of this study is it is from a single centre, there are
small numbers and lastly some of the results are limited by patients
leaving Western Australia or transitioning to adult services. Lessons
learnt included – Routine screening for CFRD using OGTTs in children
and young people with CF can be challenging. Rates of screening can be
improved with a series of PDSA cycles. Such enhanced screening resulted
in newly diagnosed cased of CFRD. However further work is required to
determine how to get to 100% annually. Abnormal glycaemic control is
common in a contemporary population of children and young people with
CF, despite improved health compared to historical cohorts, and
increasing use of CFTR modulator therapy. Screening is still required,
as there are patients with impaired glucose tolerance and CFRD with no
change symptoms like weight loss, and reduced FEV1. They
may also already be on modulator therapy.
This quality improvement project showed an improvement in screening for
CFRD in a CF cohort, which was the original aim. CF care is changing
however ongoing screening for abnormal glycaemic control is required.
Over the next decade as modulator therapy becomes more available and at
a younger age – screening for current complications may need to be
lessened.