Introduction Nutrition plays a pivotal role in long-term survival of Cystic Fibrosis (CF) patients and worsening catabolic state affects the respiratory reserve. Management of glucose intolerance with early insulin treatment promotes anabolism and stabilises lung function. However there is a variation in CFRD screening procedure across various centres (the recommended age at start of diabetes screening varies between 10–12 years as per CF trust, CFF and ISPAD guidelines).
Aim To assess if early screening of glycaemic status helps in early identification of glucose intolerance in patients with CF and to evaluate the correlation between OGTT and glycosylated haemoglobin (HbA1c).
Methodology Retrospective data on OGTT, HbA1c and patient demographics were collected on all CF patients in a tertiary paediatric hospital (n = 84, 35M). Patients were categorised into 3 age groups [<10, 10 to <12 and ≥12 years]. The data was analysed to assess the incidence of glucose intolerance and to compare OGTT and HbA1c.
Results 35 CF patients underwent a total of 127 OGTT with median age of 13 years (range 3–17.3) and median follow up of 4 years (range 0.8–11.1). OGTT: Eleven patients (13%) were diagnosed with CFRD requiring various forms of insulin therapy including insulin pump. This includes 3 patients diagnosed with CFRD as a result of the early OGTT screening between the age of 10 and 12 years (27%). OGTT was undertaken in children less than 10 years of age if they were symptomatic and this has identified one CFRD patient at the age of 9.4 years. Five eligible patients (≥10 years of age) did not undergo OGTT [Table 1]. HbA1c: 89 HbA1c analyses were undertaken along with simultaneous OGTT (Table 2). The HbA1c was ≤42mmol/mol in patients with IGT and >42mmols/mol in patients with postprandial hyperglycaemia.
Conclusions 1. Application of CFF guideline (CFRD screening ≥10 years of age) promotes early diagnosis and management of CFRD. 2. OGTT may not be routinely needed in children <10 years of age unless there are strong clinical indications. 3. A national consensus guideline on CFRD screening would be very useful in early diagnosis and management of CFRD in paediatric population.
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