Tsurumi Tomoki, Tamura Yuma, Nakatani Yuki, Furuya Tomoki, Tamiya Hajime, Terashima Masato, Tomoe Takashi, Ueno Asuka, Shimoyama Masahiro, Yasu Takanori
Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, Nikko 321-2593, Japan.
Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center, Nikko 321-2593, Japan.
J Clin Med. 2022 Oct 22;11(21):6239. doi: 10.3390/jcm11216239.
Hemodialysis patients with diabetic kidney disease (DKD) experience blood glucose fluctuations owing to insulin removal. We evaluated the effects of single and long-term application of neuromuscular electrical stimulation (NMES) during hemodialysis on glycemic control. This trial was conducted in two stages: Stage 1, following a crossover design and 4 week washout period, eleven outpatients with DKD either underwent a single bout of NMES for 30 min (NMES period) or rested (control period) after receiving nutritional support during hemodialysis; Stage 2, following a crossover design and 4 week washout period, each participant received the intervention for 12 weeks. NMES was administered for 30 min at the maximum tolerable intensity. The mean subcutaneous glucose concentration and mean amplitude of glycemic excursion (MAGE) were determined by flash glucose monitoring for 24 h. Changes in glycoalbumin and MAGE before and after NMES initiation were evaluated. The mean blood glucose level and MAGE after a single bout of NMES were significantly lower than those after rest. Glycoalbumin levels and echo intensity of the rectus femoris tended to decrease, but not significantly by ANOVA due to a lack in statistical power after the dropout of three patients. NMES in end-stage DKD decreased blood glucose levels during and after hemodialysis.
患有糖尿病肾病（DKD）的血液透析患者由于胰岛素清除而出现血糖波动。我们评估了血液透析期间单次和长期应用神经肌肉电刺激（NMES）对血糖控制的影响。本试验分两个阶段进行：第1阶段，采用交叉设计和4周洗脱期，11名DKD门诊患者在血液透析期间接受营养支持后，要么接受30分钟的单次NMES治疗（NMES期），要么休息（对照期）；第2阶段，采用交叉设计和4周洗脱期，每位参与者接受12周的干预。以最大耐受强度给予NMES 30分钟。通过24小时动态葡萄糖监测测定平均皮下葡萄糖浓度和血糖波动幅度（MAGE）的平均值。评估NMES开始前后糖化白蛋白和MAGE的变化。单次NMES后的平均血糖水平和MAGE显著低于休息后。由于三名患者退出后统计功效不足，糖化白蛋白水平和股直肌回声强度有下降趋势，但方差分析未显示显著差异。终末期DKD患者进行NMES可降低血液透析期间及透析后的血糖水平。
