Accuracy of a Factory-Calibrated Continuous Glucose Monitor in Individuals With Diabetes on Hemodialysis

Abstract

OBJECTIVE Continuous glucose monitoring (CGM) improves diabetes management, but its reliability in individuals on hemodialysis is poorly understood and potentially affected by interstitial and intravascular volume variations. RESEARCH DESIGN AND METHODS We assessed the accuracy of a factory-calibrated CGM by using venous blood glucose measurements (vBGM) during hemodialysis sessions and self-monitoring blood glucose (SMBG) at home. RESULTS Twenty participants completed the protocol. The mean absolute relative difference of the CGM was 13.8% and 14.4%, when calculated on SMBG (n = 684) and on vBGM (n = 624), and 98.7% and 100% of values in the Parkes error grid A/B zones, respectively. Throughout 181 days of CGM monitoring, the median time in range (70–180 mg/dL) was 38.5% (interquartile range 29.3–57.9), with 28.7% (7.8–40.6) of the time >250 mg/dL. CONCLUSIONS The overall performance of a factory-calibrated CGM appears reasonably accurate and clinically relevant for use in practice by individuals on hemodialysis and health professionals to improve diabetes management.

The role of real‐time continuous glucose monitoring in diabetes management and how it should link to integrated personalized diabetes management

“…rtCGM has the potential to overcome some of these challenges, but limited studies have reported the accuracy of rtCGM in people with diabetes on haemodialysis. [28][29][30] Currently, most rtCGM devices are not validated or approved for use in people on dialysis as per manufacturer's guidance because of a limited evidence base in this cohort.…”

“…Overall assessment of glycaemia in end‐stage renal disease is difficult as classical markers such as HbA1c may underestimate glycaemia because of a shortened erythrocyte lifespan and does not differentiate glycaemia on the days on and off dialysis. rtCGM has the potential to overcome some of these challenges, but limited studies have reported the accuracy of rtCGM in people with diabetes on haemodialysis 28–30 . Currently, most rtCGM devices are not validated or approved for use in people on dialysis as per manufacturer's guidance because of a limited evidence base in this cohort.…”

Continuous Glucose Monitoring to Optimize Management of Diabetes in Patients with Advanced CKD

“…These studies have demonstrated the ability to identify CGM patterns in patients on hemodialysis (72,73) and assess the reliability of current measurement methodologies (74,76,77). Indeed, a recent study of patients with diabetes receiving hemodialysis reported reasonable accuracy and clinical utility of the factory-calibrated Dexcom G6 Pro CGM, concluding that use of the device holds promise for assessment of glycemic control and informing clinical management decisions (78). Recently, two pilot clinical trials evaluated the safety and efficacy of a closed-loop system (CamAPS HX Close Loop; CamDiab), including a Dexcom G6 CGM and the Dana Diabcare RS insulin pump, among patients treated with hemodialysis.…”

Evaluation of a Fourth-Generation Subcutaneous Real-Time Continuous Glucose Monitor (CGM) in Individuals With Diabetes on Peritoneal Dialysis

“…The latest Kidney Disease Improving Global Outcomes (KDIGO) guideline advocates the use of periodic continuous glucose monitoring (CGM) alongside HbA 1c in stage 4 to 5 chronic kidney disease ( 5 ). Recently published studies focused on the evaluation of accuracy of CGM in HD patients ( 6 – 8 ). However, few studies have been conducted in PD patients ( 9 , 10 ), mostly using self-monitoring of blood glucose (SMBG) as the comparator within a limited glycemic range.…”