Continuous glucose monitoring in an end‐stage renal disease patient with diabetes receiving hemodialysis

Abstract

Diabetes is the leading cause of end‐stage renal disease (ESRD) and contributes to heightened morbidity and mortality in dialysis patients. Given that ESRD patients are susceptible to hypoglycemia and hyperglycemia via multiple pathways, adequate glycemic monitoring and control is a cornerstone in diabetic kidney disease management. In ESRD, existing glycemic metrics such as glycated hemoglobin, self‐monitored blood glucose, fructosamine, and glycated albumin have limitations in accuracy, convenience, and accessibility. In contrast, continuous glucose monitoring (CGM) provides automated, less invasive glucose measurements and more comprehensive glycemic data versus conventional metrics. Here, we report a 48‐year‐old male with ESRD due to diabetes receiving thrice‐weekly hemodialysis who experienced decreased patient‐burden, greater glucose monitoring adherence, improved glycemic parameters, and reduction in hypoglycemia after transitioning to CGM. Through this case, we discuss how CGM is a practical, convenient patient‐centered tool that may improve metabolic outcomes and quality of life in ESRD patients with diabetes.

Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease

“…In non-CKD patients, clinical trials have shown that CGM is superior to SMBG in hypoglycemia detection and improved clinical outcomes. Several studies support the agreement of blood versus CGM-based interstitial glucose levels in advanced CKD patients [74–76], and anecdotal reports suggest that CGM may be a more practical, patient-centered tool in ESRD patients with diabetes [73 ▪ ]. Although clinical practice guidelines support the use of daily glycemic monitoring with CGM in CKD patients with diabetes [52], particularly in the context of use of glucose-lowering pharmacotherapies with hypoglycemia risk, such as insulin and insulin secretagogues (sulfonylureas, glinides), this convenient tool remains under-utilized in the kidney disease population.…”

“…>10 times/day) has been shown to result in better glycemic control, such that the ADA advises at least 6–10 daily SMBG measurements in patients with diabetes receiving intensive insulin regimens [72], frequent capillary fingerstick measurements may be inconvenient, burdensome, and painful for patients. Furthermore, the above-mentioned glycemic metrics do not adequately capture daily glucose dynamics, including asymptomatic, nocturnal, nor intra-dialytic hypoglycemia and hyperglycemia events [11 ▪ ,73 ▪ ].…”

“…In contrast, continuous glucose monitoring (CGM) has emerged as a convenient, automated, and less invasive method for providing comprehensive glycemic data as compared with the above-mentioned conventional metrics [11 ▪ ,73 ▪ ]. In non-CKD patients, clinical trials have shown that CGM is superior to SMBG in hypoglycemia detection and improved clinical outcomes.…”

What Nephrologists Should Know about the Use of Continuous Glucose Monitoring in Type 2 Diabetes Mellitus Patients on Chronic Hemodialysis

“…Regarding the potential advantages of the long-term use of personal CGM, published data are extremely limited. A recently published case report illustrated the utility of transitioning from SBMG to CGM in terms of decreasing patient burden, improving glucose monitoring adherence, improving glucose metrics (especially less glycemic variability and increased TIR) and reducing hypoglycemia occurrence after 2 years of follow-up [45]. The patient included in this case report was relatively young (49 years) and very motivated to use CGM for the long term.…”

Use of Continuous Glucose Monitors in the Hospital: The Diabetes Technology Society Hospital Meeting Report 2023

“…Source: Reproduced from Narasaki et al 15 with permission from John Wiley & Sons—Books; permission conveyed through Copyright Clearance Center, Inc.…”