Hicks Rebecca, Marks Brynn E, Oxman Rachael, Moheet Amir
Division of Pediatric Endocrinology, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave., MDCC 22-315, Los Angeles, CA, USA.
Division of Endocrinology and Diabetes, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, USA.
J Clin Transl Endocrinol. 2021 Oct 13;26:100267. doi: 10.1016/j.jcte.2021.100267. eCollection 2021 Dec.
Spontaneous episodes of hypoglycemia can occur in people with cystic fibrosis (CF) without diabetes, who are not on glucose lowering medications. Spontaneous hypoglycemia in CF could occur both in the fasting or postprandial state (reactive hypoglycemia). The pathophysiology of fasting hypoglycemia is thought to be related to malnutrition and increased energy expenditure in the setting of inflammation and acute infections. Reactive hypoglycemia is thought to be due to impaired first phase insulin release in response to a glucose load, followed by a delayed and extended second phase insulin secretion; ineffective counterregulatory response to dropping glucose levels may also play a role. The overall prevalence of spontaneous hypoglycemia varies from 7 to 69% as examined with oral glucose tolerance test (OGTT) or with continuous glucose monitoring (CGM) under free living conditions. Spontaneous hypoglycemia in CF is associated with worse lung function, higher hospitalization rates, and worse clinical status. In addition, patients with CF related diabetes on glucose-lowering therapies are at risk for iatrogenic hypoglycemia. In this article, we will review the pathophysiology, prevalence, risk factors, clinical implications, and management of spontaneous and iatrogenic hypoglycemia in patients with CF.
患有囊性纤维化（CF）但未患糖尿病且未服用降糖药物的人可能会出现自发性低血糖发作。CF患者的自发性低血糖在空腹或餐后状态（反应性低血糖）下均可能发生。空腹低血糖的病理生理学被认为与营养不良以及炎症和急性感染情况下能量消耗增加有关。反应性低血糖被认为是由于对葡萄糖负荷的第一相胰岛素释放受损，随后是延迟和延长的第二相胰岛素分泌；对血糖水平下降的无效反调节反应也可能起作用。在自由生活条件下，通过口服葡萄糖耐量试验（OGTT）或连续血糖监测（CGM）检查，自发性低血糖的总体患病率在7%至69%之间。CF患者的自发性低血糖与更差的肺功能、更高的住院率和更差的临床状态相关。此外，接受降糖治疗的CF相关糖尿病患者有发生医源性低血糖的风险。在本文中，我们将综述CF患者自发性和医源性低血糖的病理生理学、患病率、危险因素、临床意义及管理。
