Glycaemic control in type 2 diabetic patients on chronic haemodialysis: use of a continuous glucose monitoring system.
BACKGROUND
The proportion of diabetic patients undergoing haemodialysis is rapidly increasing. Glucose control among such patients is difficult to assess. We aimed to evaluate the clinical performance of a continuous glucose monitoring system (CGMS) in type 2 diabetic patients on chronic haemodialysis.


METHODS
We used a 4-day CGMS to monitor glucose levels in 19 haemodialysed type 2 diabetic patients (HD T2) including 2 days with and 2 days without dialysis session, and 39 non-HD T2 in a double-centre study.


RESULTS
The glucose concentration according to the glucose meter and CGMS were correlated in HD T2 patients (r = 0.90, P < 0.0001) and in non-HD T2 patients (r = 0.81, P < 0.0001). The relative absolute difference (RAD) between glucose determined by a glucose meter and glucose determined by the CGMS did not differ between HD T2 and non-HD T2 patients (9.2 +/- 10.5 vs. 8.2 +/- 7.6%; P = 0.165). Glycated haemoglobin (A1c) and mean glucose concentration were strongly correlated in non-HD T2 patients (r = 0.71; P < 0.0001) but weakly correlated in HD T2 patients (r = 0.47; P = 0.042). Fructosamine was correlated with the mean glucose concentration in non-HD T2 (r = 0.67; P < 0.0001) but not in HD T2 patients (r = 0.04; P = 0.88).


CONCLUSIONS
CGM is a validated marker of glycaemic control in HD diabetic patients. This tool showed that A1c and fructosamine, despite being good markers of glycaemic control in non-HD diabetic patients, are of poor value in HD diabetic patients.
Riveline
Jean-Pierre
JP
Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France.
Teynie
Julie
J
Belmouaz
Simohamed
S
Franc
Sylvia
S
Dardari
Dured
D
Bauwens
Marc
M
Caudwell
Valérie
V
Ragot
Stéphanie
S
Bridoux
Frank
F
Charpentier
Guillaume
G
Marechaud
Richard
R
Hadjadj
Samy
S
D000368:Aged; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000097:blood* / Q000628:therapy*; D005260:Female; D019270:Fructosamine / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
D001786:Blood Glucose; D019270:Fructosamine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human