Use of continuous glucose monitoring system in patients with type 2 mellitus diabetic during hemodialysis treatment

Abstract

Background Studies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre® is the most used in worldwide, but there is still no consensus on its use in dialysis. Method A 3-week prospective study was performed with 12 patients comparing capillary and interstitial glucose during dialysis. Results Comparing capillary and interstitial measurements, similar values were observed in pre-dialysis in the 1st week (184.1 ± 69.5 mg/dl and 173.1 ± 78.9 mg/dl, respectively, p = 0.303), in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2 mg/dl and 201.3 ± 77.0 mg/dl respectively, p = 0.466), in those dialysis fluid loss less than 2 l (185.5 ± 82.6 mg/dl and 183.1 ± 94.0 mg/dl respectively and p = 0.805) and in those with hemoglobin greater than 12 g/dl (152.0 ± 35, 5 mg/dl and 129.5 ± 47.4 mg/dl respectively, p = 0.016). In the correlation of the capillary measurement with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0%, 10.4% and 0.0% respectively and in the Parkes error grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. Conclusion The mean absolute relative difference in dialysis patients is higher than the general population without end-stage renal disease. However, clinical decision-making based on the values measured by the system can be made with a good margin based on the correlation between interstitial and capillary measurements.

Use of a Continuous Glucose Monitoring System in High-Risk Hospitalized Noncritically Ill Patients With Diabetes After Cardiac Surgery and During Their Transition of Care From the Intensive Care Unit During COVID-19: A Pilot Study

“…[ 29 ] Other studies have also demonstrated a higher MARD in patients with type 2 diabetes on dialysis. [ 30 , 31 ] In addition, studies assessing CGM accuracy intentionally excluded patients with severely impaired renal function presumably due to lower accuracy. [ 32 ] The subjects with advanced CKD IV and V in our study were more prone to hypoglycemia (glucose < 70 mg/dl) and significant anemia (mean hemoglobin 8.2 g/dl) - two circumstances associated with a higher MARD.…”

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

“…The accuracy in patients on hemodialysis is not affected by hydration status measured via impedance spectroscopy ( 97 ). A small study in twelve patients ( 98 ) showed better MARD at the beginning of the dialysis treatment (r=0.731) compared to the end of the treatment session (r=0.513), and overall 90% of the paired measurments were in the zones A/B (clinically accurate or no risk from error) of the Clarke error grid. A recent study evaluating the Dexcom G6 CGM in patients with type 1 and type 2 diabetes during dialysis showed an overall MARD 13.8% (interquartile range 4.9-18.2%) when CGM was compared to matched SBGM measurements ( 99 ).…”

Use of Continuous Glucose Monitoring in the Assessment and Management of Patients With Diabetes and Chronic Kidney Disease

“…Mean absolute relative difference (MARD) was 19.5% ± 13.2% for Freestyle Libre versus 8.1% ± 7.6% for Medtronic iPro2 (48). In a three-week study comparing the accuracy Freestyle Libre versus capillary blood glucose in 12 patients on haemodialysis, the MARD was found to be higher than people without ESKD (49). Only one study had evaluated the accuracy of Medtronic iPro2 ™ with Enlite ™ sensor in 40 patients on PD.…”