Publication Date

11-2021

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Abstract

Background: Cystic fibrosis–related diabetes (CFRD) is a common comorbidity among people with CF (PwCF). It is associated with weight loss, protein catabolism, lung function decline, and increased mortality. Nutritional status and pulmonary function begin to decline in PwCF several years before the diagnosis of CFRD. Early CFRD detection and aggressive insulin therapy have been shown to reduce the mortality gap between PwCF who have CFRD and those who do not. The Clinical Care Guidelines for Cystic Fibrosis–Related Diabetes recommend annual screening for people with CF starting at age 10 [1]. Methods: In 2011, team members at Children’s Mercy Kansas City (CMKC) embarked on a quality improvement (QI) project focused on improving oral glucose tolerance test (OGTT) completion rates in PwCF. During the initial phase of this project, QI methodology including fishbone diagrams and process flowcharts were employed to identify barriers to obtaining OGTTs. Patient education materials (English and Spanish) detailing the importance of and process for completing OGTTs were developed and distributed annually. A database for tracking PwCF who are greater than 10 years old and require OGTT was created. Weekly monitoring of upcoming appointments helped ensure that testing opportunities were not missed. Efforts were made to schedule OGTTs with annual laboratory testing to reduce phlebotomy. PwCF who wished to schedule with a local laboratory or provider were encouraged to do so and were provided with outside orders as needed. When PwCF in this group were admitted to the hospital, every attemptwas made to complete OGTTs near the end of their hospitalization. Results: Due to the lack of a standardized process and education, previous OGTT screening rates were poor: 9% in 2008, 13% in 2009, and 25% in 2010. During the first year of standard interventions (2011), the rate rose to 77%. By identifying barriers and standardizing our process, OGTT completion rates have continued to rise. In 2019 our OGTT completion rate was 92%, and in 2020—despite the COVID-19 pandemic which eliminated 3 months of testing opportunities—it was 81%. In recent years, endocrinology has partnered with the CF team in monthly CF/endocrinology “combo clinics,” which allow PwCF who have impaired glucose tolerance or CFRD to be evaluated by an endocrinology provider during their routine CF clinic visit. Conclusion: This QI project was initiated in 2011 and quality improvement work has continued to the present day. Continued education of PwCF and their families, tracking of testing, and commitment to sustained quality have allowed CMKC to attain high rates of OGTT completion. Earlier identification of impaired glucose tolerance and CFRD has allowed for earlier interventions, including dietary modifications, exercise recommendations, and endocrinology involvement in the plan of care.

Disciplines

Medicine and Health Sciences | Pediatrics | Pulmonology

Notes

Presented at the North American Cystic Fibrosis Conference, November 2-5, 2021, Virtual.

Optimizing oral glucose tolerance test completion at a pediatric cystic fibrosis care center: A 10-year continuing quality improvement effort

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