Canadian Cystic Fibrosis-related Diabetes Clinical Practice Survey: Analysis of Current Practices and Gaps in Clinical Care

Kathryn J Potter; Adèle Coriati; Patrick Hicks; Larry C Lands; Martha L McKinney; Valérie Boudreau; Anne Bonhoure; Paola Luca; Josephine Ho; Sémah Tagougui; Amanda Jober; Meghan Pohl; Elizabeth T Rosolowsky; Julie Gilmour; Grace Y Lam; Anne L Stephenson; Peter A Senior; Rémi Rabasa-Lhoret; Tamizan Kherani

doi:10.1016/j.jcjd.2023.02.002

Canadian Cystic Fibrosis-related Diabetes Clinical Practice Survey: Analysis of Current Practices and Gaps in Clinical Care

Can J Diabetes. 2023 Apr;47(3):263-271.e1. doi: 10.1016/j.jcjd.2023.02.002. Epub 2023 Feb 11.

Authors

Kathryn J Potter¹, Adèle Coriati², Patrick Hicks³, Larry C Lands⁴, Martha L McKinney³, Valérie Boudreau¹, Anne Bonhoure¹, Paola Luca⁵, Josephine Ho⁵, Sémah Tagougui⁶, Amanda Jober³, Meghan Pohl³, Elizabeth T Rosolowsky⁷, Julie Gilmour⁸, Grace Y Lam⁹, Anne L Stephenson¹⁰, Peter A Senior¹¹, Rémi Rabasa-Lhoret¹², Tamizan Kherani³

Affiliations

¹ Montréal Clinical Research Institute, Montréal, Québec, Canada.
² Montréal Clinical Research Institute, Montréal, Québec, Canada; Division of Respirology, St. Michael's Hospital, Toronto, Ontario, Canada.
³ Division of Pediatric Respirology, University of Alberta, Edmonton, Alberta, Canada.
⁴ Division of Pediatric Respirology, McGill University, Montréal, Québec, Canada.
⁵ Division of Pediatric Endocrinology, University of Calgary, Calgary, Alberta, Canada.
⁶ Montréal Clinical Research Institute, Montréal, Québec, Canada; Université Lille, Université Artois, Université Littoral Côte d'Opale, ULR 7369, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France.
⁷ Division of Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada.
⁸ Division of Endocrinology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
⁹ Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada.
¹⁰ Division of Respirology, St. Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
¹¹ Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.
¹² Montréal Clinical Research Institute, Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Cystic Fibrosis Clinic, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada; Division of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada; Division of Endocrinology, Faculty of Medicine, Department of Medicine, Université de Montréal, Montréal, Québec, Canada. Electronic address: Remi.Rabasa-Lhoret@ircm.qc.ca.

PMID: 36872137
DOI: 10.1016/j.jcjd.2023.02.002

Abstract

Objectives: Our aim in this study was to identify challenges and gaps in Canadian practices in screening, diagnosis, and treatment of cystic fibrosis-related diabetes (CFRD), with the goal of informing a Canadian-specific guideline for CFRD.

Methods: We conducted an online survey of health-care professionals (97 physicians and 44 allied health professionals) who care for people living with CF (pwCF) and/or CFRD (pwCFRD).

Results: Most pediatric centres followed <10 pwCFRD and adult centres followed >10 pwCFRD. Children with CFRD are usually followed at a separate diabetes clinic, whereas adults with CFRD may be followed by respirologists, nurse practitioners, or endocrinologists in a CF clinic or in a separate diabetes clinic. Less than 25% of pwCF had access to an endocrinologist with a special interest or expertise in CFRD. Many centres perform screening oral glucose tolerance testing with fasting and 2-hour time points. Respondents, especially those working with adults, also indicate use of additional tests for screening not currently recommended in CFRD guidelines. Pediatric practitioners tend to only use insulin to manage CFRD, whereas adult practitioners are more likely to use repaglinide as an alternative to insulin.

Conclusions: Access to specialized CFRD care may be a challenge for pwCFRD in Canada. There appears to be wide heterogeneity of CFRD care organization, screening, and treatment among health-care providers caring for pwCF and/or pwCFRD across Canada. Practitioners working with adult pwCF are less likely to adhere to current clinical practice guidelines than practitioners working with children.

Keywords: A1C; CF; CFRD; DLFK; FK; HGPO; HbA1c; OGTT; clinical practice survey; cystic fibrosis; cystic fibrosis–related diabetes; diabéte lié á la fibrose kystique; dépistage; efibrose kystique; enquête sur la pratique clinique; oral glucose tolerance test; screening; traitement; treatment; épreuve de l'hyperglycémie provoquée par voie orale.

MeSH terms

Adult
Blood Glucose
Canada / epidemiology
Child
Cystic Fibrosis* / complications
Cystic Fibrosis* / diagnosis
Cystic Fibrosis* / therapy
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / etiology
Diabetes Mellitus* / therapy
Glucose Tolerance Test
Humans
Insulin / therapeutic use

Substances

Insulin
Blood Glucose