Assessing glycemic control in maintenance hemodialysis patients with type 2 diabetes.
OBJECTIVE
Optimizing glycemic control in diabetic patients undergoing maintenance hemodialysis requires accurate assessment. We hypothesize that 1) 48-h continuous glucose monitoring (CGM) provides additional, clinically relevant, information to that provided by the A1C measurement and 2) glycemic profiles differ significantly between day on and day off dialysis.


METHODS
With the use of GlucoDay S, 48-h CGM was performed in 19 type 2 diabetic subjects undergoing hemodialysis to capture consecutive 24-h periods on and off dialysis. Energy intake was calculated using food diaries. A1C was assayed by a high-performance liquid chromatography method.


RESULTS
CGM data were available for 17 subjects (13 male) with a mean (range) age of 61.5 years (42-79 years) and diabetes duration of 18.8 years (4-30 years). The 24-h CGM area under the glucose curve and 24-h mean glucose values were significantly higher during the day off dialysis than on dialysis (5,932.1 +/- 2,673.6 vs. 4,694 +/- 1,988.0 mmol x 3 min(-1) x l(-1), P = 0.022, and 12.6 +/- 5.6 vs. 9.8 +/- 3.8 mmol/l, P = 0.013, respectively), independent of energy intake. Asymptomatic hypoglycemia occurred in 4 subjects, 3 within 24 h of dialysis, and the glucose nadir in 14 subjects occurred within 24 h of dialysis.


CONCLUSIONS
Glucose values are significantly lower on dialysis days than on nondialysis days despite similar energy intake. The risk of asymptomatic hypoglycemia was highest within 24 h of dialysis. Physicians caring for patients undergoing hemodialysis need to be aware of this phenomenon and consider enhanced glycemic monitoring after a hemodialysis session. CGM provides glycemic information in addition to A1C, which is potentially relevant to clinical management.
Kazempour-Ardebili
Sara
S
Department of Investigative Medicine, Imperial College London, Hammersmith Campus, London, UK. s.kazempour@imperial.ac.uk
Lecamwasam
Varunika L
VL
Dassanyake
Thushara
T
Frankel
Andrew H
AH
Tam
Frederick W K
FW
Dornhorst
Anne
A
Frost
Gary
G
Turner
Jeremy J O
JJ
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index; D006454:Hemoglobins / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D018579:Patient Selection; D006435:Renal Dialysis
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006454:Hemoglobins; D007004:Hypoglycemic Agents