Unmet Published Guidelines for CF-Related Diabetes Can Be ‘Incompletely Successful’, Study Shows

Because some cystic Fibrosis (CF) clinics often fail to follow published guidelines for the screening and care of diabetes in CF patients, but self-implemented ways can produce better patient outcomes, a recent study suggests that optimal care can differ from recommendations.

CF-related diabetes is an increasingly common complication in CF patients, resulting in substantial morbidity. Guidelines for patient care were developed in a joint effort by the U.S. CF Foundation and American Diabetes Association, but several other studies showed that the guidelines were not always used.

The study, “Improving performance in the detection and management of cystic fibrosis-related diabetes in the Mountain West Cystic Fibrosis Consortium,“ published in the journal BMJ Open Diabetes Research and Care, examined the issue.

University of Utah researchers measured adherence to recommended screening procedures and care for CF-related diabetes patients before and after self-implemented improvements. The study included several treatment centers in Arizona, Colorado, New Mexico, and Utah.

Each clinic developed individual plans for improving diabetes screening, and how to better monitor and treat CF diabetics. Researchers measured the quality of screening and care procedures before the implementation of the changes, and again after one year.

Measurements before study start showed that 91 percent of patients had been screened by any available method. But despite efforts to improve screening procedures, the number dropped to 75 percent two years later.

Testing according to the more strict recommendations was lower at study start; 14 percent of patients were screened using the oral glucose tolerance test, and 9.4 percent using fasting blood glucose measurements. The numbers did not change after the attempted improvement, possibly mirroring the fact that more robust tests are also more difficult to perform.

Though testing decreased, more patients were diagnosed with diabetes by the end of the study — 12 versus 17 percent. Clinics also performed significantly more examinations to detect possible complications of diabetes, such as foot, and eye retina examinations. Tests measuring protein in the urine, a procedure to detect diabetic kidney disease, also increased.

Additionally on the plus side, better adherence to the guidelines resulted in patient weight improvement.

The research team concluded: “Improving adherence with CFRD [CF-related diabetes] care guidelines requires substantial effort and may be incompletely successful, particularly for CFRD screening, but the effort may significantly improve patient monitoring and clinically relevant outcomes such as weight.”