Influence of Dialysis on the Glucose Profile in Patients with Diabetes: Usefulness of Continuous Glucose Monitoring

Abstract

We sought to investigate the impact of dialysis on glucose profiles of diabetic patients using continuous glucose monitoring (CGM). The study included 33 hemodialyzed patients with diabetes (14 females and 19 males; mean age: 66±8 years; patients with type 2 diabetes: 30; mean duration of dialysis: 3.8±2.6 years) who were under insulin treatment. After a run-in period, CGM was performed for 48 h, including a dialysis session. Three CGM sessions were proposed for each patient over a 3-month period. CGM results were analyzed during and after dialysis at 6 different time points. Moreover, data were analyzed in 7 different day periods according to meals. Of the 99 CGM available, 21 were excluded because of technical issues or patient refusal. The CGM results indicated that mean glucose values (7.5±2.5 mmol/l vs. 9.4±1.9 mmol/l; p<0.001) and variability indices (p<0.001) were lower, whereas the frequency of hypoglycemia (4.4±9.6% vs. 2.1±7.9%; p<0.001) was higher during hemodialysis sessions. Significant differences were observed in glucose values only before and 2 h after breakfast (p<0.001). Compared with other day periods, glucose values were lower during the second half of the night and higher before and after dinner (p<0.001). In summary, CGM allows the identification of a particular glucose profile in hemodialyzed diabetic patients. CGM seems feasible and clinically useful for the analysis of glucose profiles in this group of patients.

Effects of DPP-4 Inhibitors on Blood Glucose Variability in Japanese Patients with Type 2 Diabetes on Maintenance Hemodialysis: A Prospective Observational Exploratory Study

“…Continuous glucose monitoring (CGM) is useful for elucidating BG variability in diabetes patients by analyzing the amplitude and timing of glucose fluctuations [22]. CGM is now commonly used for monitoring BG levels in patients undergoing maintenance hemodialysis [9,10,[23][24][25][26][27][28][29][30][31][32]. Nonetheless, there are only a few detailed reports on BG variability during hemodialysis therapy.…”

When ESKD complicates the management of diabetes mellitus

“…In particular, hypoglycemia was more likely to occur during the 24 hours after a dialysis session, with a glucose nadir typically occurring during the 12 hours post‐dialysis in a majority of individuals 52 . During dialysis sessions and within the interdialytic period, fluid shifts between the interstitial fluid and intravascular space, uremia, acidosis, and volume overload all may impact the performance of the currently available CGM devices 52‐54 …”

Determination of Glucose Levels during Dialysis Treatment: Different Sensors and Technologies

“…The other two CGM devices of the last generation were used in a few studies: Navigator (Abbott, Rungis, France) in studies [36,37] and DexCom SEVEN PLUS (DexCom, CA, USA) in study [38]. Technologies, operations, and calibration procedures of these devices are similar to those described above.…”