#3637 ROLE OF CONTINUOUS GLUCOSE MONITORING OF BLOOD GLUCOSE CONTROL IN PATIENTS WITH DIABETES UNDERGOING HEMODIALYSIS: A PILOT STUDY
Authors: Lee Sua , Hwang Seokjin , Heo Seung Woo , Park Bo Sun , Lee Soyoung , Kim Kyeong Min , Shin Jong Ho 
Published: June 2023

Abstract

Background and Aims
End-stage kidney disease (ESKD) is a global health problem, with a steep increase in its prevalence. Diabetes is a major cause and common comorbidity in patients with ESKD. As already known, glycemic control is an important factor in preventing micro- and macrovascular complications in diabetes. Besides, glycemic variability has recently been considered an important factor in the treatment of diabetes. However, both hypoglycemia and hyperglycemia can frequently occur in patients with diabetes undergoing hemodialysis. This study aimed to determine the role of continuous glucose monitoring (CGM) for glycemic control and glycemic variability stabilization in patients with diabetes undergoing hemodialysis.

Method
Eighteen patients aged ≥18 years with type 1 or 2 diabetes and ≥3 months on hemodialysis at the Eulji Medical Center, Daejeon, Republic of Korea between November 2021 and May 2022 were included. Patients underwent 7-day CGM twice: the baseline study period (T0) and the follow-up study period (T1), at a 12-week interval. Physicians modified the treatment strategy according to the T0 results, and then patients conducted T1. iPro2 CGM (MMT-7745) and Enlite glucose sensors MMT-7008A (Medtronic Minimed, Northridge, CA, USA) were used to assess glycemic control. As indicators of glycemic control, the mean glucose levels and glycated hemoglobin A1c (HbA1c) were measured. As indicators of glycemic variability, standard deviation (SD) and %coefficient variation (%CV) were measured.

Results
Data from 18 patients were analyzed. The mean age was 62.0±11.2 years, male/female ratio was 13 (72.2%)/5 (27.8%). The mean dialysis duration was 5.2±3.5 years. Among the 18 patients, only one had type 1 diabetes, and the mean diabetes duration was 22.9±7.0 years. The mean glucose levels decreased from 179.1±42.3 mg/dL during T0 to 153.2±25.6 mg/dL during T1 (P = 0.001). HbA1c decreased from 7.4±1.3% during T0 to 6.9±1.2% during T1 (P = 0.023). SD improved from 55.7±19.8 mg/dL during T0 to 42.6±15.3 mg/dL during T1 (P = 0.001). %CV improved from 30.5±7.3% during T0 to 25.5±5.5% during T1 (P &lt; 0.001). During T0, the mean glucose level was significantly lower on a day with hemodialysis than on a day without (P≪0.05), and SD and %CV were significantly higher on a day with hemodialysis than on a day without (P≪0.05). After the physicians modified the treatment according to the T0 results, the mean blood glucose levels decreased on both the hemodialysis-on and hemodialysis-off days, as compared to those values during T0 (from 174.7±46.5 to 154.6±29.7 mg/dL, and from 184.7±50.5 to 156.3±28.7 mg/dL, respectively), and consequently there were no statistically significant differences between the hemodialysis-on and hemodialysis-off days during T1 (P = 0.638). SD improved on both the hemodialysis-on and hemodialysis-off days compared to those values during T0 (from 46.9±21.5 to 33.2±14.6, and from 39.5±20.6 to 32.3±13.3, respectively), and consequently, there were no statistically significant differences between the hemodialysis-on and hemodialysis-off days during T1 (P = 0.384). %CV improved from 27.8±10.9 on the hemodialysis-on day during T0 to 21.4±9.2 on that during T1, and there was no statistically significant difference between the hemodialysis-on and hemodialysis-off days during T1 (P = 0.166).

Conclusion
CGM could be a promising tool for individualizing treatment strategies in patients with diabetes undergoing hemodialysis.