title: Continuous glucose monitoring in hemodialyzed patients with type 2 diabetes: a multicenter pilot study.
abstract: OBJECTIVE
  Hemodialyzed patients with diabetes face an increased cardiovascular risk. Optimal glycemic control can reduce morbidity and mortality, but it is difficult to achieve because of the alternation between dialysis and non-dialysis periods. This study evaluated the contribution of continuous glucose monitoring (CGM) to the management of insulin regimen.
  
  
  METHODS
  In this pilot prospective multicenter study, we performed CGM (Navigator®, Abbott, Rungis, France) for a total of 54 hours at baseline and for a 3-month follow-up period in a group of 28 hemodialyzed patients with type 2 diabetes treated by a basal-bolus detemir plus aspart insulin regimen. Insulin therapy was adapted to the CGM values. HbA1c and CGM parameters collected over the 3-month treatment period were compared using MANOVA for repeated measures.
  
  
  RESULTS
  After 3 months, HbA1c significantly decreased from 8.4 ± 1.0% (65 ± 1 mmol/mol) to 7.6 ± 1.0% (60 ± 11 mmol/mol; p < 0.01). Similarly, mean CGM glucose values significantly decreased from 9.9 ± 1.9 to 8.9 ± 2.1 mmol/L (p = 0.05). The frequency of glucose values > 10 mmol/L significantly decreased from 41.3 ± 21.9% to 30.1 ± 22.4% (p < 0.05), without a significant increase in the frequency of glucose values < 3.3 mmol/L. Insulin requirements significantly increased from 70 ± 51 IU/d to 82 ± 77 IU/d (p < 0.001), without significant changes in body weight.
  
  
  CONCLUSIONS
  CGM-adapted insulin regimen improves glycemic control without increasing hypoglycemic events in hemodialyzed diabetic patients. CGM could be a useful tool for the management of insulin therapy in these patients. These results need to be confirmed by long-term studies with larger sample sizes.
authors.forename: Lori
authors.initials: L
authors.lastname: Képénékian
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Smagala
authors.forename: Laurent
authors.initials: L
authors.lastname: Meyer
authors.forename: Olivier
authors.initials: O
authors.lastname: Imhoff
authors.forename: Farideh
authors.initials: F
authors.lastname: Alenabi
authors.forename: Liviu
authors.initials: L
authors.lastname: Serb
authors.forename: Dominique
authors.initials: D
authors.lastname: Fleury
authors.forename: François
authors.initials: F
authors.lastname: Dorey
authors.forename: Thierry
authors.initials: T
authors.lastname: Krummel
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Le Floch
authors.forename: François
authors.initials: F
authors.lastname: Chantrel
authors.forename: Laurence
authors.initials: L
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000379:methods; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D061267:Insulin Aspart / Q000008:administration & dosage / Q000627:therapeutic use; D000069057:Insulin Detemir / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D061267:Insulin Aspart; D000069057:Insulin Detemir