False Hyperglycemies in Diabetic Patients Using Icodextrin in Peritoneal Dialysis

Abstract

BACKGROUND Monitoring blood glucose is an important part of integral management of peritoneal dialysis (PD) patients with diabetes. Nowadays, several systems of glucometers are commercially available, and practically all are based on 3 enzymatic reactions. The two systems used most often are glucose oxidase (GOD) and glucose dehydrogenase using pyrroloquinolinequinone cofactor (GDH/PQQ). On the other hand, icodextrin (Extraneal) is an isosmotic PD solution containing glucose polymers. Accumulation in the systemic circulation of icodextrin metabolites may lead to a disparity between fi nger‐stick and formal blood glucose measurement. METHODS We analyzed the possible interference of icodextrin metabolites with various glucose assays in 9 diabetic patients undergoing PD using icodextrin. RESULTS The simple regression test showed a good association between central laboratory values and the Ascensia Breeze II (Bayer) glucometer:GOD (r = 0.928; p < 0.0001), the One Touch Ultra (Johnson and Johnson): GOD (r = 0.911; p < 0.0002), and the Glucocard Memory 2 (Menarini):GOD (r = 0.966; p < 0.00001). Nevertheless, the Accu‐chek Aviva (Roche):GDH/PQQ showed poor correlation (r = 0.353; p = 0.317) with the laboratory results. It has been suggested that maltose interferes with glucose assays that use glucose dehydrogenase with GDH/PQQ, leading to falsely increased readings. Our results confirmed that GDH/PQQ devices overestimated glucose levels in these patients CONCLUSIONS We concluded that patients with diabetes mellitus treated by icodextrin‐PD are at risk of having erroneous blood glucose measurements using GDH/PQQ‐based glucometers. Careful attention needs to be given to checking that the glucose devices used in these patients are based on GOD, GDH with a different PQQ cofactor, or hexokinase methods in order to minimize the risk of hypoglycemies due to an overdose of insulin.

The Evaluation of Drug Delivery Nanocarrier Development and Pharmacological Briefing for Metabolic-Associated Fatty Liver Disease (MAFLD): An Update

“…Additionally, there is a need to investigate glucose-lowering polymer synergetic effects, such as cellulose, which positively impacts diabetes mellitus type 2 [ 87 , 88 , 89 ], and inulin, which was reported to reduced serum insulin levels but simultaneously increased body weight in diabetic rats [ 90 ]. Thus, preliminary studies are recommended when exploring glucose-polymers as excipients for nanoparticles, such as dextrans, icodextrin, and amylose, to ensure that there are no short-term or long-term consequences on MAFLD patients, including the blood glucose levels [ 91 , 92 , 93 , 94 ].…”