Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：我们在这项研究中的目的是确定加拿大在筛查实践中的挑战和差距，囊性纤维化相关性糖尿病（CFRD）的诊断和治疗，目的是为CFRD提供加拿大特定的指南。
方法：我们对护理CF（pwCF）和/或CFRD（pwCFRD）患者的医疗保健专业人员（97名医生和44名专职医疗专业人员）进行了一项在线调查。
结果：大多数儿科中心遵循<10pwCFRD，成人中心遵循>10pwCFRD。患有CFRD的儿童通常在单独的糖尿病诊所进行随访，而患有CFRD的成年人可能会被呼吸科医生跟踪，CF诊所或单独的糖尿病诊所的护士或内分泌学家。不到25％的pwCF与对CFRD有特殊兴趣或专业知识的内分泌学家接触。许多中心在空腹和2小时时间点进行口服葡萄糖耐量筛查。Respondents,尤其是那些和成年人一起工作的人，还表明使用CFRD指南中目前不推荐的其他筛查测试。儿科从业者倾向于只使用胰岛素来管理CFRD，而成年医生更有可能使用瑞格列奈作为胰岛素的替代品.
结论：对于加拿大的pwCFRD来说，获得专业CFRD护理可能是一个挑战。CFRD护理组织似乎存在广泛的异质性，在加拿大各地照顾pwCF和/或CFRD的医疗保健提供者中进行筛查和治疗。与与儿童一起工作的从业者相比，与成人pwCF一起工作的从业者不太可能遵守当前的临床实践指南。
方法：我们对护理CF（pwCF）和/或CFRD（pwCFRD）患者的医疗保健专业人员（97名医生和44名专职医疗专业人员）进行了一项在线调查。
结果：大多数儿科中心遵循<10pwCFRD，成人中心遵循>10pwCFRD。患有CFRD的儿童通常在单独的糖尿病诊所进行随访，而患有CFRD的成年人可能会被呼吸科医生跟踪，CF诊所或单独的糖尿病诊所的护士或内分泌学家。不到25％的pwCF与对CFRD有特殊兴趣或专业知识的内分泌学家接触。许多中心在空腹和2小时时间点进行口服葡萄糖耐量筛查。Respondents,尤其是那些和成年人一起工作的人，还表明使用CFRD指南中目前不推荐的其他筛查测试。儿科从业者倾向于只使用胰岛素来管理CFRD，而成年医生更有可能使用瑞格列奈作为胰岛素的替代品.
结论：对于加拿大的pwCFRD来说，获得专业CFRD护理可能是一个挑战。CFRD护理组织似乎存在广泛的异质性，在加拿大各地照顾pwCF和/或CFRD的医疗保健提供者中进行筛查和治疗。与与儿童一起工作的从业者相比，与成人pwCF一起工作的从业者不太可能遵守当前的临床实践指南。
