Glycemic Pattern in Diabetic Patients on Hemodialysis: Continuous Glucose Monitoring (CGM) Analysis

Abstract

Background/Aims: Recent evidences suggest that hemodialysis (HD) induces glycemic variations in diabetic patients. Continuous glucose monitoring (CGM) devices measure interstitial glucose in a ‘Holter-like' manner thereby improving the glycemic control assessment method. Methods: A CGM device (Medtronic iPRO) was used on 12 diabetic patients with chronic HD for 6 days to assess intra- and extra-dialytic interstitial glucose. Results: In all enrolled patients, HD was associated with a decrease of interstitial glucose values. Intradialytic glucose nadir was 79 mg/dl and it was reached at the third hour after the beginning of the session. At the end of HD, interstitial glucose increased in all patients and a glycemic peak (187 mg/dl) occurred after an average time of 2.5 h. No episodes of nocturnal hypoglycemia occurred. Conclusion: HD is associated with significant intradialytic reduction of glycemia and postdialytic hyperglycemia. CGM devices result in better monitoring of glycemic trends in diabetic patients on chronic HD and could improve insulin management.

Glycemic Variability and Hemodialysis

“…Ayrıca SD ve MAGE dü-zeyleri HD gününde daha yüksek bulunmuştur. 18 HD yapılmadığı gün oluşan düşük glisemik ortalamanın, büyük olasılıkla diyaliz sonrası (insülin direncine neden olan metabolik asidozun ve üremik ortamın düzelmesine bağlı) artmış insülin duyarlı-lığı nedeni ile günlük insülin gereksiniminde azalmaya bağlı olduğu düşünülmektedir.…”

“…18,19 Hipoglisemi riski, HD seansı sonrası 24 saatte en yüksek seviyede olduğundan hastaların glisemik takip sayısını artırmaları ve gerekirse kullanılan insülin doz miktarlarını düşürmeleri gerekmektedir.…”

Comparison of Glycemic Markers in Chronic Hemodialysis Using Continuous Glucose Monitoring

“…Studies evaluating the utility of newer devices performing interstitial continuous glucose monitoring (CGM) have shown that this method can detect asymptomatic hypoglycemia and assess the variations in blood glucose levels during the intra- and interdialytic periods [15-18]. These studies are once again limited by their small sample size, short duration of CGM, and by the absence, in most of them, of simultaneous assessment of glycated analogs in order to test their accuracy in detecting poor glycemic control [15-18].…”

“…These studies are once again limited by their small sample size, short duration of CGM, and by the absence, in most of them, of simultaneous assessment of glycated analogs in order to test their accuracy in detecting poor glycemic control [15-18]. Accordingly, the aim of this study was to explore among diabetic hemodialysis patients (i) the validity of CGM-derived interstitial glucose measurements against self-measured capillary glucose and (ii) the accuracy of alternative glycemic biomarkers (such as GA and GSP) versus HbA1c in detecting uncontrolled diabetes assessed on the basis of a huge number of interstitial glucose measurements obtained over a 7-day-long CGM.…”

Development of a Novel Scheme for Long-Term Body Temperature Monitoring: A Review of Benefits and Applications

“…Continuous monitoring of certain clinical variables, either at bedside or ambulatory, provides important information about the physiological and pathophysiological state of the patient that would otherwise not be accessible [1,2]. Furthermore, in contrast to intermittent monitoring, continuous monitoring can have a positive influence on the prognosis and outcomes [3,4].…”