Subscribe to RSS
DOI: 10.1055/s-0034-1370963
Influence of Dialysis on the Glucose Profile in Patients with Diabetes: Usefulness of Continuous Glucose Monitoring
Publication History
received 02 October 2013
accepted 12 February 2014
Publication Date:
13 March 2014 (online)
![](https://www.thieme-connect.de/media/hmr/201411/lookinside/thumbnails/10.1055-s-0034-1370963-1.jpg)
Abstract
We sought to investigate the impact of dialysis on glucose profiles of diabetic patients using continuous glucose monitoring (CGM). The study included 33 hemodialyzed patients with diabetes (14 females and 19 males; mean age: 66±8 years; patients with type 2 diabetes: 30; mean duration of dialysis: 3.8±2.6 years) who were under insulin treatment. After a run-in period, CGM was performed for 48 h, including a dialysis session. Three CGM sessions were proposed for each patient over a 3-month period. CGM results were analyzed during and after dialysis at 6 different time points. Moreover, data were analyzed in 7 different day periods according to meals. Of the 99 CGM available, 21 were excluded because of technical issues or patient refusal. The CGM results indicated that mean glucose values (7.5±2.5 mmol/l vs. 9.4±1.9 mmol/l; p<0.001) and variability indices (p<0.001) were lower, whereas the frequency of hypoglycemia (4.4±9.6% vs. 2.1±7.9%; p<0.001) was higher during hemodialysis sessions. Significant differences were observed in glucose values only before and 2 h after breakfast (p<0.001). Compared with other day periods, glucose values were lower during the second half of the night and higher before and after dinner (p<0.001). In summary, CGM allows the identification of a particular glucose profile in hemodialyzed diabetic patients. CGM seems feasible and clinically useful for the analysis of glucose profiles in this group of patients.
-
References
- 1 United States Renal Data System. Atlas of Chronic Kidney Disease & End-Stage Renal Disease. 2012 Available from http://www.usrds.org/atlas.aspx accessed 15 March 2013
- 2 Heras M, Fernández-Reyes MJ, Sánchez R, Guerrero MT, Molina A, Rodríguez MA, Alvarez-Ude F. Elderly patients with chronic kidney disease: outcomes after 5 years of follow-up. Nefrol 2012; 32: 300-305
- 3 Pieringer H, Biesenbach G. Hemodialysis in patients older than 65 years with end-stage renal failure. Z Gerontol Geriatr 2008; 41: 139-145
- 4 Sattar A, Argyropoulos C, Weissfeld L, Younas N, Fried L, Kellum JA, Unruh M. All-cause and cause-specific mortality associated with diabetes in prevalent hemodialysis patients. BMC Nephrol 2012; 13: 130
- 5 DCCT . The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. N Engl J Med 1993; 329: 977-986
- 6 UKPDS . Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. The Lancet 1998; 352: 837-853
- 7 McMurray SD, Johnson G, Davis S, McDougall K. Diabetes education and care management significantly improve patient outcomes in the dialysis unit. Am J Kidney Dis 2002; 40: 566-575
- 8 Shurraw S, Hemmelgarn B, Lin M, Majumdar SR, Klarenbach S, Manns B, Bello A, James M, Turin TC, Tonelli M. Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: a population-based cohort study. Arch Intern Med 2011; 171: 1920-1927
- 9 Drechsler C, Krane V, Ritz E, März W, Wanner C. Glycemic Control and Cardiovascular Events in Diabetic Hemodialysis Patients. Circulation 2009; 120: 2421-2428
- 10 Cano N. Inter-relationships between renal metabolism (both in physiology and renal dysfunction) and the liver. Curr Opin Clin Nutr Metab Care 2001; 4: 279-285
- 11 Bailey JL. Insulin resistance and muscle metabolism in chronic kidney disease. ISRN Endocrinol 2013; 2013: 329-360
- 12 Cersosimo E, Garlick P, Ferretti J. Renal substrate metabolism and gluconeogenesis during hypoglycemia in humans. Diabetes 2000; 49: 1186-1193
- 13 Meyer L, Chantrel F, Imhoff O, Sissoko A, Serb L, Dorey F, Krummel T, Lefoch JP, Kessler L. Glycated albumin and continuous glucose monitoring to replace glycated haemoglobin in patients with diabetes treated with haemodialysis. Diabet Med 2013; [Epub ahead of print]
- 14 Poolsup N, Suksomboon N, Kyaw AM. Systematic review and meta-analysis of the effectiveness of continuous glucose monitoring (CGM) on glucose control in diabetes. Diabetol Metab Syndr 2013; 5: 39
- 15 Raccah D, Sulmont V, Reznik Y, Guerci B, Renard E, Hanire H, Jeandidier N, Nicolino M. Incremental Value of Continuous Glucose Monitoring When Starting Pump Therapy in Patients With Poorly Controlled Type 1 Diabetes, The RealTrend study. Diabetes Care 2009; 32: 2245-2250
- 16 Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, Zieve FJ, Marks J, Davis SN, Hayward R, Warren SR, Goldman S, McCarren M, Vitek ME, Henderson WG, Huang GD. VADT Investigators . Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360: 129-139
- 17 Gerstein HC, Miller ME, Byington RP, Goff Jr DC, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm Jr RH, Probstfield JL, Simons-Morton DG, Friedewald WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545-2559
- 18 Sobngwi E, Ashuntantang G, Ndounia E, Dehayem M, Azabji-Kenfack M, Kaze F, Balti E, Mbanya JC. Continuous interstitial glucose monitoring in non-diabetic subjects with end-stage renal disease undergoing maintenance haemodialysis. Diabetes Res Clin Pract 2010; 90: 22-25
- 19 Riveline J-P, Teynie J, Belmouaz S, Franc S, Dardari D, Bauwens M, Caudwell V, Ragot S, Bridoux F, Charpentier G, Marechaud R, Hadjadj S. Glycaemic control in type 2 diabetic patients on chronic haemodialysis: use of a continuous glucose monitoring system. Nephrol Dial Transplant 2009; 24: 2866-2871
- 20 Mirani M, Berra C, Finazzi S, Calvetta A, Radaelli MG, Favareto F, Graziani G, Badalamenti S. Inter-day glycemic variability assessed by continuous glucose monitoring in insulin-treated type 2 diabetes patients on hemodialysis. Diabetes Technol Ther 2010; 12: 749-753
- 21 Jung HS, Kim HI, Kim MJ, Yoon JW, Ahn HY, Cho YMl, Oh KH, Joo KW, Lee JG, Kim SY, Park KS. Analysis of hemodialysis-associated hypoglycaemia in patients with type 2 diabetes using a continuous glucose monitoring system. Diabetes Technol Ther 2010; 12: 801-807
- 22 Kazempour-Ardebili S, Lecamwasam VL, Dassanyake T, Frankel AH, Tam FWK, Dornhorst A, Frost G, Turner JJO. Assessing glycemic control in maintenance hemodialysis patients with type 2 diabetes. Diabetes Care 2009; 32: 1137-1142
- 23 Monnier L, Colette C, Sardinoux M, Baptista G, Regnier-Zerbibi A, Owens D. Frequency and severity of the dawn phenomenon in type 2 diabetes: relationship to age. Diabetes Care 2012; 35: 2597-2599