Clinical Characteristics and Early Treatment Patterns of Newly Diagnosed Cystic Fibrosis–Related Diabetes in Two Tertiary Centers

The 2010 ADA/CFRD guidelines have recommended insulin for CFRD. However, these recommendations are often not followed in clinical practice. We performed a chart review of newly diagnosed CFRD patients at University of California Davis (UCD) and University of Florida (UF) for years 2011-2015.

Six new CFRD patients were diagnosed at UCD and 19 at UF. A BMI over 25 was more common in UCD than at UF (50% vs. 11%), whereas a BMI below 20 was more common at UF (0% vs. 21%). The prevalent method of diagnosis was A1c at UCD (100%) and OGTT at UF (63%). One year after diagnosis, insulin was prescribed in 31% of UF patients and none at UCD. A weight loss >3% was observed in 21% of patients in the preceding year at UF but none at UCD. The only patient started on insulin at UCD did so 14 months after the diagnosis whereas the median time was 4.5 months at UF. Of note, the OGTT screening rate was lower at UCD. Because OGTT detects CFRD earlier than A1c, patients diagnosed via OGTT would have experienced less weight loss, not more. While it remains unclear what accounts for the higher BMI at UCD, better nutritional status could have delayed the decision to initiate insulin.

In conclusion, newly diagnosed CFRD patients have divergent characteristics at different centers. Further studies assessing social and dietary differences can serve to evaluate center-to-center variations.