Accuracy of Flash Glucose Monitoring in Hemodialysis Patients With and Without Diabetes Mellitus

Abstract

Aims Glucose and insulin metabolism are altered in hemodialysis patients and diabetes management is difficult in these patients. We aimed to validate flash glucose monitoring in hemodialysis patients with and without diabetes mellitus as an attractive option for glucose monitoring not requiring regular self-punctures. Methods We measured interstitial glucose using a Freestyle Libre device in 8 hemodialysis patients with and 7 without diabetes mellitus over 14 days and compared the results to simultaneously performed self-monitoring of capillary blood glucose. Results In 720 paired measurements, mean flash glucose values were significantly lower than self-measured capillary values (6.12  2.52 vs. 7.15  2.39 mmol/l, p=1.3 E-86). Overall, mean absolute relative difference was 17.4% and mean absolute difference 1.20 mmol/l. The systematic error was significantly larger in patients without vs. with diabetes (-1.17 vs. -0.82 mmol/l) and on dialysis vs. interdialytic days (-1.09 vs. -0.90 mmol/l). Compared to venous blood glucose (72 paired measurements), the systematic error of flash glucose monitoring was even larger (5.89  2.44 mmol/l vs. 7.78  7.25 mmol/l, p = 3.74E-22). Several strategies to reduce the systematic error were evaluated, including the addition of +1.0 mmol/l as a correction term to all flash glucose monitoring values, which significantly improved accuracy. Conclusions Flash glucose monitoring systematically underestimates blood glucose in hemodialysis patients but taking this systematic error into account, the system may be useful for glucose monitoring in hemodialysis patients with or without diabetes.