Flash Glucose Monitoring to Assess Glycemic Control and Variability in Hemodialysis Patients: The GIOTTO Study

Abstract

Background: Flash glucose monitoring (FGM) is a technology with considerable differences compared to continuous glucose monitoring (CGM), but it has been scarcely studied in hemodialysis patients. Thus, we aimed assessing the performance of FGM in such patients by comparison to self-monitoring of blood glucose (SMBG). We will also focus on estimation of glycemic control and variability, and their relationships with parameters of glucose homeostasis.Methods: Thirty-one patients (20 with type 2 diabetes, T2DM, 11 diabetes-free, NODM) collected readings by FGM and SMBG for about 12 days on average. Readings by FGM and SMBG were compared by linear regression, Clarke error grid, and Bland-Altman analyses. Several indices of glycemic control and variability were computed. Ten patients also underwent oral glucose tolerance test (OGTT) for assessment of insulin sensitivity/resistance and insulin secretion/beta-cell function.Results: Flash glucose monitoring and SMBG readings showed very good agreement in both T2DM and NODM (on average, 97 and 99% of readings during hemodialysis in A+B Clarke regions, respectively). Some glycemic control and variability indices were similar by FGM and SMBG (p = 0.06–0.9), whereas others were different (p = 0.0001–0.03). The majority of control and variability indices were higher in T2DM than in NODM, according to both FGM and SMBG (p = 0.0005–0.03). OGTT-based insulin secretion was inversely related to some variability indices according to FGM (R < −0.72, p < 0.02).Conclusions: Based on our dataset, FGM appeared acceptable for glucose monitoring in hemodialysis patients, though partial disagreement with SMBG in glycemic control/variability assessment needs further investigations.

Continuous glucose monitoring in people with diabetes and end-stage kidney disease—review of association studies and Evidence-Based discussion

“… Hissa et al [ 26 ] 2021, Prospective observational study 13 FreeStyle Libre 13 T2D /10 treated with insulin A 14-day FGM was performed in 13 diabetics on hemodialysis 15. Mambelli et al [ 12 ] 2021, Prospective observational study 31 FreeStyle Libre 20 T2D/without detailed information on the number treated with insulin/ 11 T1D A 14-day FGM was performed in 20 diabetics on hemodialysis and 11 individuals without diabetes on hemodialysis 16. Hayashi et al [ 21 ] 2021, Prospective observational study 98 System Gold Medtronic in 40 patients and Medtronic iPro2 in 58 98 T2D/65 treated with insulin, 20 treated with just oral hypoglycemic agents, 7 treated with just GLP-1A, 6 treated with diet A two-day CGM was performed in 98 diabetics on hemodialysis to record the glycemic profile of the dialysis day and the off-dialysis day 17.…”

“…The quality and duration of the recording depend on the involvement in the testing process [ 8 , 9 ]. It has been proven that the latest models of continuous glucose monitoring and flash glucose monitoring sensors are characterized by high accuracy [ 10 – 12 ]. Moreover, continuous glucose monitoring is more promising in clinical practice than self-monitoring of blood glucose in terms of higher testing frequency and additional features such as assessment of glycemic trends, the use of alarms to detect abnormal glycemia (especially hypoglycemia), and the ability to track the blood glucose levels by partners, family members or healthcare professionals.…”

Making sense of glucose sensors in end-stage kidney disease: A review

“…Mambelli et al. found very good accuracy of the Abbott Libre CGM in patients with type 2 diabetes on hemodialysis, with 97% of measurements in A+B regions of the Clarke error grid ( 95 ). In contrast, another study in patients with type 2 diabetes on hemodialysis by Yajima et al.…”

What Nephrologists Should Know about the Use of Continuous Glucose Monitoring in Type 2 Diabetes Mellitus Patients on Chronic Hemodialysis

“…Data regarding FGM and rtCGM accuracy in diabetic patients undergoing chronic HD are limited. The majority of the studies were conducted with FSL, the most frequently used CGM worldwide [46][47][48][49][50][51]. Small studies have demonstrated that the accuracy of FSL is lower in diabetic HD patients, especially during HD sessions as compared to SBGM/capillary blood glucose.…”