ESPE Abstracts (2016) 86 P-P1-205

Are We Screening Appropriate Age Group for Early Diagnosis of Cystic Fibrosis Related Diabetes in UK?

Arundoss Gangadharan, Claire Berry, Ruth Watling, Sue Kerr, Kevin Southern & Senthil Senniappan

Alder Hey Children’s Hospital, Liverpool, UK

Background: Nutrition plays a pivotal role in long-term survival in cystic fibrosis (CF). Early insulin treatment for glucose intolerance promotes anabolism and stabilises lung function. However there is a variation in cystic fibrosis related diabetes (CFRD) screening across centres (recommended age for start of CFRD screening varies between 10 and 12 years as per CF trust, CFF & ISPAD guidelines).

Aims: To assess if early screening of glycaemic status helps in early identification of glucose intolerance in CF and 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 as <10, 10 to <12 & ≥12 years. The data was analysed to assess the incidence of glucose intolerance and to compare OGTT and HbA1c.

Results: Total of 127 OGTT were carried out in 35 CF patients with median age of 13 years (3–17.3) and median follow-up of 4 years(0.8–11.1). OGTT: Eleven patients (13%) were diagnosed with CFRD requiring various forms of insulin therapy including insulin pump. This includes three patients (27%) diagnosed with CFRD as a result of the early OGTT screening in 10 to <12 years. OGTT was undertaken in symptomatic children <10 years of age and identified one CFRD patient (aged 9.4 years). Five eligible patients (≥10 years of age) did not undergo OGTT (Table 1). HbA1c: Total of 89 HbA1c analyses was undertaken along with simultaneous OGTT (Table 2). The HbA1c was ≤42 mmol/mol in patients with IGT and >42 mmols/mol in patients with postprandial hyperglycaemia.

Table 1. Age groups and OGTT results (for abstract P1-P205).
GroupsAge in years median (range)OGTT
TotalNormalAbnormal (details)
<10 years6.7 (3–9.8)24231 (PP-1)
10- <12 years10.9 (10–11.7)16124 (F-2, PP-2**)
≥12 years13.8 (12–17.3)876819 (F-2, PP-7, IGT-10)
Fasting hyperglycaemia (F)=blood glucose >7.0 mmol/l, Post prandial hyperglycaemia (PP)=blood glucose ≥11.1 mmol/l, Impaired Glucose tolerance (IGT)= post prandial blood glucose between 7.8 and 11.0 mmol/l. ** Same patient had two abnormal OGTT.
Table 2. Comparison between OGTT and HbA1c (for abstract P1-P205).
OGTTHbA1c ≤ 42 mmol/molHbA1c > 42 mmol/molTotal
Abnormal12 (F-2, IGT-10)8 (F-1, PP-7)20

Conclusions: i) Application of CFF guideline (CFRD screening ≥10 years of age) promotes early diagnosis and management of CFRD. ii) OGTT may not be routinely needed in children <10 years of age unless there are strong clinical indications. iii) A national consensus guideline on CFRD screening would be very useful.

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