(60) Improving Cystic Fibrosis Related Diabetes Annual Screening in Adult CF Patients

Background: Cystic Fibrosis (CF) Related Diabetes (CFRD) is associated with decline in lung function and nutritional status. CF Foundation (CFF) guidelines recommend annual CFRD screening in patients starting at age 10. A review of our adult program data showed a decline in screening during 2020. We identified barriers, in addition to the COVID pandemic, which contributed to a decline in adherence. Additionally, in July 2020 our clinic moved to a new location and began offering morning visits. After a QI review, we began offering annual oral glucose tolerance testing (OGTT) simultaneously within a routine clinic visit and along with annual routine labs. Our objective was to use this multidisciplinary approach to improve OGTT screening to 50% within the first year of moving to our new location.

Methods: Port CF was used to compile a list of our non-diabetic eligible patients overdue for annual OGTT. The list was reviewed during our multidisciplinary pre clinic conference to identify patients that needed testing. Each patient was re-educated during clinic and barriers identified through patient interview/questionnaire(s). Common barriers to testing adherence were: length of testing time, time missed from work, COVID concerns and needle phobia. Follow up appointments were made by the nurse/nurse coordinators incorporating OGTT in conjunction with next clinic appointment for improved adherence. Patients subsequently received phone call reminders for these appointments, as well as the fasting criteria for testing.

Results: CFF Registry Report data showed a decline in OGTT screening from 26% in 2019 to 21% in 2020. We identified 76 eligible patients that needed OGTT in 2021. Patient interviews were conducted during clinic visits and barriers identified. We offered routine clinic appointments in conjunction with lab appointments to improve screening adherence. We were able to capture 7 patients in the first 6 months and 14 patients in the second 6 months to improve our OGTT screening to 28%.

Conclusions: Using a multimodal approach in a multi-disciplinary team, we improved our OGTT annual screening by 7%. The ability to incorporate recommended screening into routine clinic visits supported adherence and patient satisfaction. Limitations to OGTT screening include continued COVID concerns and transportation to clinic. We plan to continue this QI approach to increase adherence to 50% within this next year by continued consolidation of lab work/OGTT with visits and assisting patients with scheduling lab appointments and transportation to clinic.

Acknowledgements: This work was supported by the Cystic Fibrosis Foundation and Yale University.

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