Optimising diabetes care in CF population

Clinicians at The Prince Charles Hospital (TPCH) have introduced a new model of care to optimise diabetes care in people living with Cystic Fibrosis (CF).

Advancements in treatment have significantly increased the life expectancy of people living with CF with the median life expectancy now reaching 60. Endocrinologist Dr Shanal Kumar said that the increased life expectancy of people with CF brings new health challenges, specifically endocrine and metabolic complications.

“Nearly a quarter of adults with CF develop diabetes but only 19 per cent receive regular endocrine reviews,” Dr Kumar said.

“We know the risk of diabetes increases with age in people with CF and persistently elevated blood sugars can lead to a number of complications.

“The new CF modulator therapies are also associated with weight gain which raises concerns about  the potential emergence of type 2 diabetes, hypertension and other metabolic diseases which can contribute to accelerated cardiovascular disease.”

In response to these clinical changes, a CF Endocrine Service was established, encompassing dedicated endocrinologists and diabetes educator allows for in-house diabetes, metabolic and endocrine assessment and management.

It was co-designed with the adult CF team and consumers to ensure alignment on service priorities, referral criteria and clinical management pathways.

“Our pathways ensure that individuals requiring intensive specialist input, previously unavailable on a routine basis, are effectively identified and supported,” Dr Kumar said.

“We offer inpatient and outpatient consultations as well as case conferencing opportunities with other healthcare providers. This means we can provide clinical care and support for adults with CF whenever they need it including for women during early pregnancy and postpartum, and adults undergoing elective surgical procedures.”

In the CF Endocrine service’s first year of operation, it provided comprehensive diabetes management to almost 80 per cent of all the adults with CF living with diabetes and attending the centre.

“The service has not only significantly improved blood sugar control in people who accessed the service, it also positively impacted their lung function,” Dr Kumar said.

“Establishing the CF Endocrine Service has shifted the focus in the ageing CF population from the lungs to one that addresses numerous modifiable factors that can contribute to a healthier, longer and improved quality of life.”