{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:28:37Z","timestamp":1790710117483,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T00:00:00Z","timestamp":1602806400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hypoglycemia in cystic fibrosis (CF), in the absence of glucose\u2010lowering therapies, has long been identified as an important issue in the management of CF. There is currently still no unifying hypothesis for its etiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aims of this study were to perform a 3\u2010h oral glucose tolerance test (OGTT) in participants with CF and (1) document glucose, insulin, glucagon, glucagon\u2010like\u2010peptide\u20101 (GLP\u20101), and glucose\u2010dependent insulinotropic peptide (GIP) release patterns within varying glucose tolerance groups during the OGTT; (2) determine the prevalence of hypoglycemia during the OGTT; and (3) define any association between hypoglycemia and patterns of insulin, glucagon, GLP\u20101, and GIP release.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eligible participants attending an adult CF clinic completed a 3\u2010h OGTT. Hypoglycemia on OGTT was defined as mild (glucose 3.4\u20133.9\u2009mmol\/L), moderate (glucose 3.1\u20133.3\u2009mmol\/L), and severe (glucose\u2009\u2264\u20093\u2009mmol\/L). Hormones were measured at fasting, 30, 60, 120, and 180\u2009min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010four participants completed the study, of which 7 had normal glucose tolerance, 12 had abnormal glucose tolerance, and 5 had cystic fibrosis related diabetes (CFRD). All participants had a delayed insulin response compared with normative data. All glucose tolerance groups showed appropriate and similar suppression of fasting glucagon. Four participants (17%) had mild hypoglycemia, three (13%) had moderate hypoglycemia, and eight (33%) had severe hypoglycemia. No participant with CFRD demonstrated hypoglycemia. Of the 19 participants without CFRD, 15 (79%) experienced hypoglycemia. Participants with hypoglycemia had greater peak glucose and insulin responses than those that did not have hypoglycemia, and this approached significance (<jats:italic>p<\/jats:italic>\u2009=\u2009.0625 for glucose and <jats:italic>p<\/jats:italic>\u2009=\u2009.0862 for insulin). No significant mean differences between GLP\u20101 and GIP release were found. There was no relationship between hypoglycemia and modulator therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Postprandial hypoglycemia was unmasked by the extension of an OGTT to 3\u2009h. Delayed and abnormal insulin release, and ineffective counter\u2010regulatory action of glucagon may have a role in its etiology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.25081","type":"journal-article","created":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T19:07:04Z","timestamp":1600715224000},"page":"3391-3399","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Hypoglycemia in cystic fibrosis during an extended oral glucose tolerance test"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7052-4238","authenticated-orcid":false,"given":"Natasha","family":"Armaghanian","sequence":"first","affiliation":[{"name":"Academic Department of Adolescent Medicine Children's Hospital at Westmead Sydney Australia"},{"name":"Discipline of Child and Adolescent Health University of Sydney Sydney Australia"},{"name":"Department of Respiratory Medicine Royal Prince Alfred Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Hetherington","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism Centre, Royal Prince Alfred Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkat","family":"Parameswaran","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Endocrinology Royal Hobart Hospital Hobart Australia"},{"name":"School of Medicine University of Tasmania Hobart Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L.","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Royal Prince Alfred Hospital Sydney Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health University of Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania P.","family":"Markovic","sequence":"additional","affiliation":[{"name":"Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders University of Sydney Sydney Australia"},{"name":"Department of Endocrinology Metabolism and Obesity Service, Royal Prince Alfred Hospital Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Brand\u2010Miller","sequence":"additional","affiliation":[{"name":"School of Life and Environmental Sciences and Charles Perkins Centre University of Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Steinbeck","sequence":"additional","affiliation":[{"name":"Academic Department of Adolescent Medicine Children's Hospital at Westmead Sydney Australia"},{"name":"Discipline of Child and Adolescent Health University of Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-0586"},{"issue":"12","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.2337\/dc10-1279","article-title":"Epidemiology, pathophysiology, and prognostic implications of cystic fibrosis\u2013related diabetes: a technical review","volume":"33","author":"Moranoran A","year":"2010","journal-title":"Diabetes Care"},{"issue":"12","key":"e_1_2_8_4_1","first-page":"2697","article-title":"Clinical care guidelines for cystic fibrosis\u2010related diabetes: a position statement of the American Diabetes Association and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society","volume":"33","author":"Moranoran A","year":"2010","journal-title":"Diabetes Care"},{"issue":"3","key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1530\/eje.1.02344","article-title":"Spontaneous hypoglycemia in patients with cystic fibrosis","volume":"156","author":"Battezzatiattezzati A","year":"2007","journal-title":"Eur J Endocrinol"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2016.02.012"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-S081"},{"issue":"5","key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1177\/0115426505020005517","article-title":"Dumping syndrome: pathophysiology and treatment","volume":"20","author":"Andrew U","year":"2005","journal-title":"Nutr Clin Pract"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12178"},{"key":"e_1_2_8_10_1","unstructured":"2008 Cystic Fibrosis Foundation Maryland USA C Brunzell DS Hardin A Moran T Schindler K Schissel Managing Cystic Fibrosis\u2010Related Diabetes (CFRD): An Instruction Guide for Patients and Families"},{"key":"e_1_2_8_11_1","unstructured":"Cystic Fibrosis Trust UK Cystic fibrosis\u2010related diabetes [Internet last updated2012].https:\/\/www.cysticfibrosis.org.uk\/media\/127524\/FS_Related_Diabetes_Mar_13.pdf. 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