Dietary manipulation to improve glycaemic control in young people with cystic fibrosis related diabetes

Chief Investigator	Institution	Dates	Funding Stream	Amount
Birch,  Laura	University of Bristol Biomedical Research Centre	01/09/2015 - 30/04/2017	A&B Spring 2014	£18,958

 

Summary

Cystic Fibrosis is a genetically inherited, life-limiting condition that predominantly affects the respiratory and gastro-intestinal systems. Advances in the management of cystic fibrosis mean that life expectancy is improving, but as longevity increases so does the incidence of complications such as cystic fibrosis-related diabetes. The combination of diabetes and cystic fibrosis is associated with increased morbidity and mortality; deterioration in respiratory, clinical and nutritional status occurs. Treatment regimes for people with cystic fibrosis are demanding and impact significantly on daily life. Developing cystic fibrosis-related diabetes has important health implications and further complicates cystic fibrosis management through the need for daily insulin injections and blood tests to measure blood sugar levels. From diagnosis, people with cystic fibrosis are encouraged to consume high-sugar, energy dense foods in order to maintain their weight, but this diet can lead to poor diabetes control in cystic fibrosis-related diabetes. Clinical experience at Bristol Royal Hospital for Children suggests that high sugar consumption in young people with cystic fibrosis-related diabetes causes significant hyperglycaemic episodes that are difficult to manage with insulin therapy. This study will assess the effectiveness and acceptability of tailored dietary manipulation to reduce sugar consumption in young people with cystic fibrosis-related diabetes to improve their blood sugar control whilst maintaining the total energy content of their dietary intake. If dietary manipulation can reduce hyperglycaemic episodes whilst maintaining the necessary energy density of the diet and also proving acceptable to individuals, this will provide direct patient benefit through improved glycaemic control.

Work carried out

Ethical approval was received 16/10/2015 from East Midlands - Leicester Central Research Ethics Committee (REC Ref: 15/EM/0185).

Seven patients under the care of NHS UHBristol Trust CF services were recruited to the study (Recruitment period: April - July 2016). Recruitment rate: 70%. All participants consented to Phase 1 of the study: baseline data collection of dietary intake and glycaemic control using an online dietary recall tool and continuous glucose monitoring, respectively. Four participants undertook Phase 2 of the study: development and implementation of dietary manipulation to improve glycaemic control. Participants followed the individualised dietary manipulation plan developed for 2 weeks as per protocol. Two participants were lost to follow up after the baseline data collection period. Following baseline data assessment, the planned dietary manipulation (Phase 2) was not required for one participant as this individual was already achieving optimal glycaemic control. This participant did take part in the qualitative aspect of Phase 3 of the study. Four participants fully completed Phase 3 of the study: Assessment of effectiveness and acceptability of dietary manipulation. Dietary intake and glycaemic control were re-measured as per baseline and individual qualitative interviews were conducted to evaluate acceptability of the dietary manipulation and to explore the issues surrounding glycaemic control in CF more widely.

Main findings

The preliminary data from this study form the development work underpinning a feasibility study which is being conducted as part of a NIHR Clinical Doctoral Research Fellowship.

Impact

This development work has enabled funding to be secured to undertake a feasibility study of dietary intervention to improve glycaemic control in young people with cystic fibrosis and altered glucose handling.

Other outcomes

• This project has enabled a collaboration to be developed with the UK CF Trust who have invested funding to support this work throughout the duration of my NIHR Fellowship. https://www.youtube.com/watch?v=v3iNbPWMJXU.
• Clinical collaborations with CF colleagues at Bristol, Birmingham, Liverpool and London NHS Trusts have also been established and are being developed throughout the course of my NIHR Fellowship.

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Outputs

 

Updated 21/01/2020