Continuous glucose monitoring detects spontaneous reactive and fasting hypoglycaemia in cystic fibrosis adults without diabetes

People with cystic fibrosis (pwCF) experience a spectrum of glucose disorders. Spontaneous hypoglycaemia is a unique entity affecting pwCF and can be an incidental finding on biochemistry. Our prospective, single-arm pilot study of eight pwCF without confirmed diabetes and incidental biochemical hypoglycaemia found 62.5% demonstrated fasting or reactive hypoglycaemia on continuous glucose monitoring (CGM). The remaining individuals without hypoglycaemia on CGM demonstrated dysglycaemia consistent with pre-diabetes. Symptomatic spontaneous hypoglycaemia captured on CGM was successfully managed with dietary modifications and dipeptidyl peptidase-4 inhibitor in all participants. Whether spontaneous hypoglycaemia precedes progression to pre-diabetes and overt diabetes in pwCF requires further evaluation.