Continuous Glucose Monitoring Improves Detection of Glycemic Excursions in Hemodialysis Patients With Type 2 Diabetes

Abstract

Context: Optimal glucose management in individuals with type 2 diabetes (T2D) and end-stage kidney disease (ESKD) on hemodialysis is challenging.

Objective: We compared the detection of glycemic excursions with continuous glucose monitoring (CGM) and capillary blood glucose testing (CBG) in this population.

Methods: In this prospective observational study, insulin-treated adults with T2D on hemodialysis for 90 or more days wore a Dexcom G6-Pro CGM. Participants were instructed to perform CBG testing up to 4 times daily. We compared differences in glucose metrics and described CGM patterns in relation to dialysis sessions.

Results: Among 59 participants (age 57.7 ± 9 years, glycated hemoglobin A1c 7.09%), mean glucose measured by CBG and CGM was 165.7 ± 41.8 and 188.9 ± 45.0, with a time-in-range (TIR) of 68% ± 23 and 51% ± 26, respectively (P < .001). CGM detected that all participants had hyperglycemic episodes of 180 mg/dL, with time above range (TAR) of 180 mg/dL of 47.8% ± 27, and 90% had episodes greater than 250 mg/dL, with TAR greater than 250 mg/dL of 20.9% ± 21.7. CGM detected higher rates of hypoglycemia of less than 70 mg/dL, (47% vs 25%; P = .005) and less than 54 mg/dL, (25% vs 12%; P = .08) compared with CBG testing. Nocturnal and prolonged hypoglycemia less than 70 mg/dL were detected only by CGM (29% and 12%, respectively). CGM showed a pattern of improved glucose levels on predialysis days, lower glucose levels during hemodialysis, and a rapid rise during the postdialysis period.

Conclusion: In participants with T2D and ESKD on hemodialysis, CGM improved the detection of hyperglycemic and hypoglycemic events, particularly nocturnal and prolonged episodes. CGM revealed distinct glycemic patterns related to dialysis sessions, potentially enabling more personalized management.

Keywords: CGM; diabetes; hemodialysis; hypoglycemia.