Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel, Basel, Switzerland.
Exp Clin Endocrinol Diabetes. 2023 Mar;131(3):132-141. doi: 10.1055/a-1978-0226. Epub 2022 Nov 14.
Glucose and insulin metabolism are altered in hemodialysis patients, and diabetes management is difficult in these patients. We aimed to validate flash glucose monitoring (FGM) in hemodialysis patients with and without diabetes mellitus as an attractive option for glucose monitoring not requiring regular self-punctures.
We measured interstitial glucose using a FreeStyle Libre device in eight hemodialysis patients with and seven without diabetes mellitus over 14 days and compared the results to simultaneously performed self-monitoring of capillary blood glucose (SMBG).
In 720 paired measurements, mean flash glucose values were significantly lower than self-measured capillary values (6.17±2.52 vs. 7.15±2.41 mmol/L, p=1.3 E-86). Overall, the mean absolute relative difference was 17.4%, and the mean absolute difference was 1.20 mmol/L. The systematic error was significantly larger in patients without vs. with diabetes (- 1.17 vs. - 0.82 mmol/L) and on dialysis vs. interdialytic days (-1.09 vs. -0.90 mmol/L). Compared to venous blood glucose (72 paired measurements), the systematic error of FGM was even larger (5.89±2.44 mmol/L vs. 7.78±7.25 mmol/L, p=3.74E-22). Several strategies to reduce the systematic error were evaluated, including the addition of +1.0 mmol/L as a correction term to all FGM values, which significantly improved accuracy.
FGM systematically underestimates blood glucose in hemodialysis patients but, taking this systematic error into account, the system may be useful for glucose monitoring in hemodialysis patients with or without diabetes.
血液透析患者的葡萄糖和胰岛素代谢发生改变，且这些患者的糖尿病管理较为困难。本研究旨在验证在伴或不伴糖尿病的血液透析患者中，即时血糖监测（FGM）作为一种无需频繁自我穿刺的有吸引力的血糖监测方法是否具有临床价值。
我们使用 FreeStyle Libre 设备测量了 8 例伴糖尿病和 7 例不伴糖尿病的血液透析患者 14 天内的间质葡萄糖水平，并将结果与同时进行的毛细血管自我血糖监测（SMBG）进行了比较。
在 720 对配对测量中，FGM 的平均血糖值明显低于自我测量的毛细血管血糖值（6.17±2.52 与 7.15±2.41mmol/L，p=1.3E-86）。总体而言，平均绝对相对差异为 17.4%，平均绝对差值为 1.20mmol/L。无糖尿病患者的系统误差明显大于有糖尿病患者（-1.17 与-0.82mmol/L），透析日的系统误差也明显大于非透析日（-1.09 与-0.90mmol/L）。与静脉血糖（72 对测量值）相比，FGM 的系统误差更大（5.89±2.44mmol/L 与 7.78±7.25mmol/L，p=3.74E-22）。评估了几种降低系统误差的策略，包括将所有 FGM 值增加 1.0mmol/L 作为校正项，这显著提高了准确性。
FGM 系统地低估了血液透析患者的血糖水平，但考虑到这种系统误差，该系统可能对伴或不伴糖尿病的血液透析患者的血糖监测有用。
