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Objective Cystic Fibrosis Foundation guidelines recommend annual diabetes screening by oral glucose tolerance test (OGTT) in pediatric patients with cystic fibrosis (CF) starting at the age of 10 years. Adherence to these guidelines proves to be challenging, and the nationwide screening rates are still considered suboptimal. The aim of this study was to assess and improve the screening rates at our large pediatric center. Methods A 4-year retrospective audit of OGTT completion among pediatric patients with CF of age ≥10 years who are not yet diagnosed with diabetes was conducted. A collaborative working group was formed to identify the barriers to screening and formulate a quality improvement plan, which was monitored and evaluated for a 9-month period. Results Diabetes screening rates determined by OGTT completion at our center showed a gradual decline during the COVID-19 pandemic from 2019 to 2022. Following the implementation of the quality improvement plan during the summer of 2023, there was a marked increase in OGTT ordering compliance by providers as well as test completion by patients. Notably, the fractional OGTT completion rate rose from 45% during the preintervention phase (January-April 2023) to 70% during the postintervention phase (May-September 2023). Conclusion Diabetes screening in pediatric patients with CF can be effectively improved by refining practices related to patient experience, care coordination, and laboratory testing strategies. [ABSTRACT FROM AUTHOR]

To estimate the metformin failure rate in women with gestational diabetes. The study was designed as a retrospective cohort of women diagnosed with gestational diabetes by the 75 g 2 h oral glucose tolerance test. Women were placed into two groups: metformin success (107 patients not requiring insulin therapy) or metformin failure (15 patients requiring the addition of, or, transition to insulin). Primary outcome: rate of metformin failure. Secondary outcomes: maternal and neonatal factors. The failure rate of metformin was 15% (19/122 women) in the study. The failure group was more likely to have 3 abnormal values on a 2-h 75 g oral glucose tolerance test (37% (n=7/19) vs. 15% (n=15/103), p=0.02). Patients who failed had higher average fasting blood glucose levels on the glucose tolerance test as well as on pretreatment fasting finger stick values. Those who failed metformin were diagnosed with gestational diabetes and started on metformin earlier in gestation. Overall low rate of metformin failure in treatment of gestational diabetes. [ABSTRACT FROM AUTHOR]

Objective: To determine the reproducibility of the oral glucose tolerance test (OGTT). Design: A retrospective study of 205 women who underwent screening for gestational diabetes. Setting: A university teaching hospital in a South African city. Sample: Women who had an abnormal OGTT had the test repeated during the same pregnancy without any diabetic or dietary advice given in the intervening time period. Methods: Women with two OGTTs in the same pregnancy had a proforma completed at the time. Completed proformas were filed and reviewed for the purpose of this study. Main outcome measure: The κ statistic was used for estimating the agreement between repeated tests using the same nominal or dichotomous scale. Results: The OGTT was repeated during the index pregnancy in 205 women and in a subset of 76 women within 17 days. The κ statistic was 0.269 for 205 women and 0.212 for 76 women for the fasting glucose value (fair strength of agreement). The κ statistic for the 2-h glucose value was 0.157 for 205 patients and 0.174 for 76 patients (slight strength of agreement). The overall OGGT classification produced κ statistics of 0.167 and 0.150 for the whole group and the 76 patients, respectively. Conclusion: The reproducibility was better with the fasting glucose and less with the 2-h result and the overall OGGT classification. Caution needs to be exercised when interpreting the single positive result of an OGTT in pregnant women. [ABSTRACT FROM AUTHOR]