Analysis of hemodialysis-associated hypoglycemia in patients with type 2 diabetes using a continuous glucose monitoring system.
BACKGROUND
Adequate glycemic control is important for patients with end-stage renal disease on maintenance hemodialysis (HD). Continuous glucose monitoring (CGM) systems are reported as a useful method for glucose monitoring in patients under maintenance HD. The object of this study was to describe glucose profiles and hypoglycemia associated with HD in diabetes patients using a CGM system.


METHODS
We recruited nine medically stable patients with type 2 diabetes under maintenance HD. CGMS System Gold (Medtronic MiniMed, Northridge, CA) was applied to the subjects for 144 h. During the period, HD using glucose-containing dialysate was performed every other day. Various glucose profiles were calculated from the CGM readings and compared between the day on and the day off dialysis.


RESULTS
Mean ± SD for age, duration of diabetes, and hemoglobin A1c were 67 ± 9 years, 24 ± 9 years, and 8.6 ± 1.2%, respectively. Hemoglobin A1c was correlated with mean glucose (ρ = 0.780, P < 0.05) and with area under the curve for glucose above 180 mg/dL (ρ = 0.797, P<0.05). Although there was no difference for mean amplitude of glycemic excursion between the day on and off HD, hypoglycemia occurred predominantly with day on HD. In the subjects who maintained antidiabetes agents with day on HD, glucose levels decreased with initiation of HD, causing significantly lower glucose levels compared to those during the equivalent time of the following day without HD.


CONCLUSIONS
According to the CGM system, glucose variability was not affected by HD. However, in spite of glucose-containing dialysate, HD seemed to increase the risk of hypoglycemia.
Jung
Hye Seung
HS
Division of Endocrinology and Metabolism, Seoul National University College of Medicine, Seoul, Republic of Korea.
Kim
Hong Il
HI
Kim
Min Joo
MJ
Yoon
Ji Won
JW
Ahn
Hwa Young
HY
Cho
Young Min
YM
Oh
Kook-Hwan
KH
Joo
Kwon Wook
KW
Lee
Jung Geon
JG
Kim
Seong Yeon
SY
Park
Kyong Soo
KS
D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications* / Q000628:therapy; D004032:Diet; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000150:complications / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human