Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Di Milano, Milano, Italy.
Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy.
Acta Diabetol. 2021 Aug;58(8):975-981. doi: 10.1007/s00592-021-01699-6. Epub 2021 Mar 20.
Diabetic kidney disease is the leading cause of end-stage kidney disease in high-income countries. The strict control of glycemic oscillations is the principal therapeutic target, but this could be hard to achieve in uremic patients due to their unpredictable insulin sensitivity. Currently, the evaluation of the glycemic profile relies on serum markers (glycated hemoglobin HbA1c, glycated albumin, and fructosamine), capillary glucose blood control (self-monitoring of blood glucose), and interstitial glucose control (continue glucose monitoring). We conducted a systematic review of published articles on continue glucose monitoring in hemodialysis patients with type 2 diabetes, which included 12 major articles. Four studies found significant fluctuations in glucose levels during hemodialysis sessions. All studies reported a higher mean amplitude of glucose variations on the hemodialysis day. Three studies agreed that continue glucose monitoring is better than glycated hemoglobin in detecting these abnormalities. Moreover, continue glucose monitoring was more accurate and perceived as easier to use by patients and their caregivers. In patients with type 2 diabetes on hemodialysis, glucose levels show different variation patterns than the patients on hemodialysis without diabetes. Considering manageability, accuracy, and cost-effectiveness, continue glucose monitoring could be the ideal diagnostic tool for the patient with diabetes on hemodialysis.
糖尿病肾病是高收入国家终末期肾病的主要病因。严格控制血糖波动是主要的治疗目标，但由于尿毒症患者的胰岛素敏感性不可预测，这可能很难实现。目前，血糖谱的评估依赖于血清标志物（糖化血红蛋白 HbA1c、糖化白蛋白和果糖胺）、毛细血管血糖控制（自我监测血糖）和间质葡萄糖控制（持续血糖监测）。我们对 12 篇主要文章进行了关于在 2 型糖尿病血液透析患者中进行持续血糖监测的已发表文章的系统评价。四项研究发现血液透析过程中血糖水平存在显著波动。所有研究均报告了血液透析日的平均血糖波动幅度更高。三项研究一致认为，与糖化血红蛋白相比，持续血糖监测在检测这些异常方面更具优势。此外，持续血糖监测更准确，患者及其护理人员认为更易于使用。在接受血液透析的 2 型糖尿病患者中，血糖水平的变化模式与未患糖尿病的血液透析患者不同。考虑到可管理性、准确性和成本效益，持续血糖监测可能是糖尿病血液透析患者的理想诊断工具。
