Li Jinzhu, Zhang Ruiqin, Wu Zhen, Guo Jiayu, Wang Zhiying, Li Shuhui, Li Chunlin, Yang Guang, Cheng Xiaoling
Department of Geriatric Nephrology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
Department of Geriatric Endocrinology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
Diabetes Ther. 2022 Jul;13(7):1353-1365. doi: 10.1007/s13300-022-01274-4. Epub 2022 Jun 11.
Patients with diabetes mellitus and end-stage renal disease are at a high risk of developing coronary, cerebrovascular, and peripheral vascular diseases. This study aimed to characterize hypoglycemia and blood glucose fluctuations associated with maintenance hemodialysis in older adult patients with diabetes mellitus and end-stage renal disease using a continuous glucose monitoring system.
Seven patients were enrolled in this study, and 13 pairs of continuous glucose monitoring system data were collected. Each pair included data of 1 dialysis-on day and 1 dialysis-off day. Information on basic patient characteristics, including age, diabetes mellitus duration, hemodialysis duration, and proportions of hemoglobin A1c and glycated albumin, were collected. Differences in blood glucose fluctuation were compared between dialysis-on days and dialysis-off days.
The mean blood glucose on dialysis-on days (6.96 ± 2.57 mmol/L) was significantly lower than that on dialysis-off days (7.68 ± 2.31 mmol/L; P < 0.05). In contrast, the following parameters had significantly higher values (all P < 0.05) on dialysis-on days compared to dialysis-off days: large amplitude of glycemic excursion level (5.82 ± 2.86 mmol/L versus 4.21 ± 1.71 mmol/L), large amplitude of glycemic excursion level from 8 a.m. to 2 p.m. (3.6 ± 1.74 mmol/L versus 2.8 ± 1.33 mmol/L), mean amplitude of glycemic excursion level (4.78 ± 1.68 mmol/L versus 3.89 ± 1.67 mmol/L), mean amplitude of glycemic excursion level from 8 a.m. to 2 p.m. (4.01 ± 1.03 mmol/L versus 3.12. ± 0.97 mmol/L), standard deviation of blood glucose (1.55 ± 0.89 mmol/L versus 1.03 ± 0.4 mmol/L), and time below a target glucose range of less than 3.9 mmol/L (8.27% versus 4.25%).
Fluctuations in blood glucose levels were larger on dialysis-on days, particularly from the start of hemodialysis to 2 h post-hemodialysis, than on dialysis-off days. Hypoglycemia, as indicated by the time below a target glucose range of less than 3.9 mmol/L, occurred more frequently on dialysis-on days than on dialysis-off days.
糖尿病和终末期肾病患者发生冠状动脉、脑血管和外周血管疾病的风险很高。本研究旨在使用连续血糖监测系统，对老年糖尿病合并终末期肾病患者维持性血液透析相关的低血糖和血糖波动情况进行特征描述。
本研究纳入7例患者，收集了13对连续血糖监测系统数据。每对数据包括1个透析日和1个非透析日的数据。收集患者的基本特征信息，包括年龄、糖尿病病程、血液透析时长以及糖化血红蛋白和糖化白蛋白的比例。比较透析日和非透析日的血糖波动差异。
透析日的平均血糖（6.96±2.57 mmol/L）显著低于非透析日（7.68±2.31 mmol/L；P<0.05）。相比之下，与非透析日相比，透析日的以下参数值显著更高（均P<0.05）：血糖波动幅度大水平（5.82±2.86 mmol/L对4.21±1.71 mmol/L）、上午8点至下午2点的血糖波动幅度大水平（3.6±1.74 mmol/L对2.8±1.33 mmol/L）、血糖波动幅度平均水平（4.78±1.68 mmol/L对3.89±1.67 mmol/L）、上午8点至下午2点的血糖波动幅度平均水平（4.01±1.03 mmol/L对3.12±0.97 mmol/L）、血糖标准差（1.55±0.89 mmol/L对1.03±0.4 mmol/L）以及血糖低于目标范围<3.9 mmol/L的时间（8.27%对4.25%）。
透析日的血糖水平波动大于非透析日，尤其是从血液透析开始至血液透析后2小时。以血糖低于目标范围<3.9 mmol/L的时间表示的低血糖在透析日比非透析日更频繁发生。
