Continuous glucose monitoring in hemodialyzed patients with type 2 diabetes: a multicenter pilot study

Képénékian, L.; Smagala, Agnieszka; Meyer, Laurent; Imhoff, O.; Alenabi, Farideh; Serb, L.; Fleury, D.; Dorey, F.; Krummel, Thierry; Floch, Jean-Pierre Le; Chantrel, F.; Kessler, L.

doi:10.5414/cn108280

Cited by 31 publications

(28 citation statements)

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“…74 A pilot study evaluated the benefit of CGM in type 2 patients with ESRD receiving hemodialysis and being treated with MDI. 75 In this study, there was a decreased HbA1c, mean CGM glucose, and hyperglycemia (over 180 mg/dL) with the CGM intervention. The study did not see a change in hypoglycemia.…”

Section: Evidence For General Benefit Of Cgm In Type 2 Diabetesmentioning

confidence: 95%

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

McGill

Ahmann

2017

Diabetes Technology & Therapeutics

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Continuous glucose monitoring (CGM) is developing into an increasingly useful tool for glucose monitoring and therapeutic guidance in the treatment of diabetes. Multiple daily doses of insulin (MDI) is the most common method for intensive insulin treatment of type 1 diabetes and is also becoming more common in the treatment of type 2 diabetes as an increasing population with type 2 diabetes experiences progressive beta cell loss. The clinical evidence demonstrating the benefit of CGM in the outcomes of patients treated with MDI is becoming clearer, particularly with the recent completion of several randomized clinical trials addressing both type 1 and 2 diabetes. This evidence is reviewed.

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Section: Evidence For General Benefit Of Cgm In Type 2 Diabetesmentioning

confidence: 95%

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

McGill

Ahmann

2017

Diabetes Technology & Therapeutics

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“…In the first study, 28 diabetic hemodialysis patients had their insulin therapy adapted to the results of a 54-h long CGM. CGM-adapted insulin therapy resulted in a significant reduction of HbA1c levels from 8.4% at baseline to 7.6% after 3 months of follow-up [29]. In the second study to explore this research question, 15 diabetic hemodialysis patients had their insulin therapy managed on the basis of self-measured capillary glucose for a period of 6 weeks followed by CGM-guided management of insulin therapy for another period of 6 weeks.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Glycemic Markers in Chronic Hemodialysis Using Continuous Glucose Monitoring

et al. 2017

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Background: Glycated hemoglobin A1c (HbA1c) among diabetic hemodialysis patients continues to be the standard of care, although its limitations are well recognized. This study evaluated glycated albumin (GA) and glycated serum protein (GSP) as alternatives to HbA1c in detecting glycemic control among diabetic hemodialysis patients using continuous-glucose-monitoring (CGM)-derived glucose as reference standard. Methods: A CGM system (iPRO) was applied for 7 days in 37 diabetic hemodialysis patients to determine glycemic control. The accuracy of GA and GSP versus HbA1c in detecting a 7-day average glucose ≥184 mg/dL was evaluated via receiver-operating-characteristic (ROC) analysis. Results: CGM-derived glucose exhibited strong correlation (r = 0.970, p < 0.001) and acceptable agreement with corresponding capillary glucose measurements obtained by the patients themselves in 1,169 time-points over the 7-day-long CGM. The area under ROC curve (AUC) for GA, GSP, and HbA1c to detect poor glycemic control was 0.976 (0.862–1.000), 0.682 (0.502–0.862), and 0.776 (0.629–0.923) respectively. GA levels >20.3% had 90.9% sensitivity and 96.1% specificity in detecting a 7-day average glucose ≥184 mg/dL. The AUC for GA was significantly higher than the AUC for GSP (difference between areas: 0.294, p < 0.001) and the AUC for HbA1c (difference between areas: 0.199, p < 0.01). Conclusion: Among diabetic hemodialysis patients, GA is a stronger indicator of poor glycemic control assessed with 7-day-long CGM when compared to GSP and HbA1c.

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“…В последнее время появился [29,30]. Кроме того, использование СМГ в сочетании с HbA1c у пациентов с СД, получающих ГД, позволяет более достоверно оценить истинное состояние углеводного обмена, по-скольку использование СМГ позволяет уменьшить влияние гипогликемических эпизодов на уровень HbA1c, так как часть гипогликемий удается предотвратить за счет своевременно выявленной тенденции к снижению уровня глюкозы в крови, а часть нераспознаваемых гипогликемий зафиксировать [31].…”

Section: ñóòî÷íîå ìîíèòîðèðîâàíèå ãëèêåìèèunclassified

Glycemic control in patients with diabetes mellitus on hemodialysis

Lobanova

Геннадьевна²,

Severina

et al. 2019

Terapevticheskii arkhiv

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Achievement of stabilization of carbohydrate metabolism in patients with diabetes mellitus, receiving renal replacement therapy with hemodialysis, is a significant problem in endocrinology. It has to do with multiple factors of this cohort of patients, which affect the level of glycemia, pharmacokinetic of drugs, the efficiency of glycemic control. At the moment, the most efficiency method of glycemic control in patients with type 2 diabetes mellitus on hemodialysis is insulin therapy in the basis - bolus regime by analogues of human insulin. The use of oral hypoglycemic agents is significantly limited. The hemoglobin A1c (HbA1c) remains the main parameter of glycemic control. The simultaneous use of continuous glucose monitoring allows to reveal the true level of glucose of the blood and to carry out the timely correction of therapy in order to achieve targets for glycemic control and to decrease the risk of hypoglycemic episodes. At the moment other glycemic control markers such as glycated albumin and fructosamine are described. However, in routine practice at the moment these indicators are not used due to the lack of sufficient evidentiary base of their use in this cohort of patients.

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Continuous glucose monitoring in hemodialyzed patients with type 2 diabetes: a multicenter pilot study

Cited by 31 publications

References 0 publications

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

Comparison of Glycemic Markers in Chronic Hemodialysis Using Continuous Glucose Monitoring

Glycemic control in patients with diabetes mellitus on hemodialysis

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