Hospital policy required that a limited number of OGTT tests could be performed each day since the patient was required to stay in the laboratory throughout the time of the test. A new protocol was developed by the hospital laboratory to provide 2 regularly scheduled appointment slots for OGTTs on the days of the CF clinics.

Many patients lived a long distance from the clinic and wanted to avoid excessively long periods of fasting. A standard laboratory order form (including dose of glucose based on weight) was developed, so that patients could obtain an OGTT at outlying hospitals.

All clinics were in the afternoon which meant a long day of fasting or giving up a morning to do the OGTT and then spending the afternoon in CF clinic.

Patients greatly disliked the length of time it took to undergo OGTT.

There was no laboratory available at clinic at the beginning of the study period. All studies were obtained at outside laboratories, and some results were not reported back to the CF clinic. Outside laboratories did not always know how to dose glucola for children and increased side effects like vomiting and rebound hypoglycemia.

Timing of 2 h postglucola challenge glucose measurements were logistically difficult in clinic even after a laboratory facility was started in clinic. The frequency of quarterly HbA1c measurements increased the logistical difficulties.

Some providers and patient families were uncomfortable with OGTT for younger patients.

All tracking was manual and difficult to perform.

There was no single endocrinologist identified to provide CFRD education increasing the potential for confusion about the disease and testing.

Patients and families did not like the extra cost of testing or the extra time.

Children often disliked the taste of glucola and had nausea and vomiting, and prediabetic patients would have insulin spikes followed by symptomatic hypoglycemia.

Standardization of procedures was difficult.

The need for education of personnel that CFRD screening and monitoring are expectations for the entire clinic population.

Patients did not like the OGTT because of the time required to complete the testing.

Patients often failed to come fasting or to even come to clinic when an OGTT was anticipated.

Small children were unable to tolerate glucola, and modified testing was required to obtain results.

Patients frequently failed to come to clinic fasting or simply declined testing during clinic.

Patients infrequently returned to clinic for OGTT and rarely went to an outside facility to obtain the test.

Patients sometimes refused testing.

Patients failed to show for some clinic visits, and some patients limited visits to clinic to once per year.