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 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 CFRD across Canada. Practitioners working
with adult pwCF are less likely to adhere to current clinical practice guidelines
than practitioners working with children.
Résumé
Objectifs
Notre objectif dans cette étude était d'identifier les défis et les lacunes dans les
pratiques canadiennes en matière de dépistage, de diagnostic et de traitement du diabète
lié à la fibrose kystique (DLFK), dans le but de renseigner une ligne directrice spécifique
au Canada pour le DLFK.
Méthodes
Nous avons mené une enquête en ligne auprès de professionnels de la santé (97 médecins
et 44 professionnels paramédicaux) qui s'occupent de personnes vivant avec la FK (pvFK)
et/ou le DLFK (pvDLFK).
Résultats
La plupart des centres pédiatriques suivaient <10 pvDLFK et les centres pour adultes
suivaient >10 pvDLFK. Les enfants atteints de DLFK sont généralement suivis dans une
clinique de diabète distincte, tandis que les adultes atteints du DLFK peuvent être
suivis par des pneumologues, des infirmières praticiennes ou des endocrinologues dans
une clinique specialisée en FK ou dans une clinique de diabète distincte. Moins de
25 % des pvFK avaient accès à un endocrinologue ayant un intérêt particulier ou une
expertise pour le DLFK. De nombreux centres effectuent des tests de dépistage de la
tolérance au glucose par voie orale à jeun et à 2 heures. Les répondants, en particulier
ceux qui travaillent avec des adultes, font également état de l'utilisation de tests
de dépistage supplémentaires qui ne sont pas actuellement recommandés dans les lignes
directrices pour le DLFK. Les praticiens en pédiatrie ont tendance à n'utiliser que
l'insuline pour gérer le DLFK, tandis que les praticiens pour adultes sont plus susceptibles
d'utiliser le repaglinide comme alternative à l'insuline.
Conclusions
L'accès à des soins spécialisés pour le DLFK peut constituer un défi pour les pvDLFK
au Canada. Il semble y avoir une grande hétérogénéité dans l'organisation des soins,
le dépistage et le traitement du DLFK parmi les fournisseurs de soins de santé qui
s'occupent des pvFK et/ou du DLFK au Canada. Les praticiens qui travaillent avec des
adultes atteints du DLFK sont moins susceptibles d'adhérer aux directives de pratique
clinique actuelles que les praticiens qui travaillent avec des enfants.
Keywords
Mots clés
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Article info
Publication history
Published online: February 10, 2023
Accepted:
February 6,
2023
Received in revised form:
January 13,
2023
Received:
July 17,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Canadian Diabetes Association.
