title: Hypoglycaemia in cystic fibrosis in the absence of diabetes: A systematic review.
abstract: Hypoglycaemia in CF in the absence of diabetes or glucose lowering therapies is a phenomenon that is receiving growing attention in the literature. These episodes are sometimes symptomatic and likely have variable aetiologies. Our first aim was to conduct a systematic review of the literature to determine what is known about hypoglycaemia in CF. Our second aim was to assess evidence based guidelines for management strategies.
  
  
  
  A comprehensive search of databases and guideline compiler entities was performed. Inclusion criteria were primary research articles and evidence based guidelines that referred to hypoglycaemia in CF in the absence of insulin treatment or other glucose lowering therapies.
  
  
  
  A total of 11 studies (four manuscripts and seven abstracts) and five evidence-based guidelines met the inclusion criteria. Prevalence rates of hypoglycaemia unrelated to diabetes varied between studies (7-69%). Hypoglycaemia was diagnosed during oral glucose tolerance testing or continuous glucose monitoring (CGM). Associations between hypoglycaemia and clinical parameters of BMI, lung function, liver disease and pancreatic insufficiency were measured in some studies. There was no unifying definition of hypoglycaemia in the absence of diabetes. Only two evidence based guidelines reported possible management strategies.
  
  
  
  The systematic review found limited data on this clinical problem and supports the need for high quality methodological studies that are able to describe the experience and the aetiology(ies) of hypoglycaemia in CF.
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Australia. Electronic address: natasha.armaghanian@health.nsw.gov.au.
authors.forename: N
authors.initials: N
authors.lastname: Armaghanian
authors.affiliation: School of Molecular Bioscience, University of Sydney, Australia; Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Australia.
authors.forename: J C
authors.initials: JC
authors.lastname: Brand-Miller
authors.affiliation: Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: T P
authors.initials: TP
authors.lastname: Markovic
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: K S
authors.initials: KS
authors.lastname: Steinbeck
mesh_terms: D003550:Cystic Fibrosis / Q000150:complications*; D019468:Disease Management; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D020380:Needs Assessment; D017410:Practice Guidelines as Topic; D015995:Prevalence
keywords: Continuous glucose monitoring; Cystic fibrosis; Hypoglycaemia; Oral glucose tolerance test