179 12 years too late? Rethinking CFRD screening

Abstract

Objectives UK practice for Cystic Fibrosis Related Diabetes (CFRD) screening varies widely. There is poor adherence to the current guidelines, which recommend annual screening of all patients >12 using oral glucose tolerance testing (OGTT). CFRD is associated with poor lung function and clinical status, and diagnosis is often made following clinical decline. Evidence linking CFRD to other morbidities supports a more proactive and sensitive screening process. We aimed to screen all CF patients >10 for CFRD using a Continuous Glucose Monitoring System (CGMS). Methods 114 CF patients were identified, of whom 52 were >10 y at the end of 2014. CGMS (Medtronic I-Pro™) was applied for 72 hours. Capillary blood glucose was independently recorded, along with a food diary. CFRD diagnosis was made in conjunction with a paediatric Diabetologist, according to International Society for Paediatric and Adolescent Diabetes (ISPAD) guidelines. Results 39/47 (83%) eligible (non-CFRD) patients were screened in 2014. Of those screened, 8 patients (21%) were diagnosed with CFRD (mean age 11.7±0.42 y), 4 (50%) of these were aged Conclusion 21% of screened patients were diagnosed with CFRD, higher than the incidence reported by the European Epidemiologic Registry of CF (ERCF, 2001) however similar to some other studies. CGMS screening at 10 y identified cases that would have otherwise been missed under current guidelines. We recommend CFRD screening at 10 y in line with new ISPAD guidelines (2014). Early CGMS and prompt treatment may prevent clinical deterioration. Future work should address the impact of earlier diagnosis and treatment on clinical outcomes and quality of life.