Lee Sua, Lee Soyoung, Kim Kyeong Min, Shin Jong Ho
Division of Nephrology, Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea.
Front Med (Lausanne). 2023 Apr 6;10:1145470. doi: 10.3389/fmed.2023.1145470. eCollection 2023.
Blood glucose stability has recently been considered important in the treatment of diabetes. Both hypoglycemia and hyperglycemia can frequently occur in patients with diabetes undergoing hemodialysis. This study aimed to determine the usefulness of continuous glucose monitoring (CGM) for glycemic control and glycemic variability stabilization in patients with diabetes undergoing hemodialysis.
Eighteen patients aged ≥18 years with type 1 or 2 diabetes and ≥3 months on hemodialysis at the Eulji Medical Center, Daejeon, Republic of Korea between November 2021 and May 2022 were included. Patients underwent days CGM twice: the baseline study period (T0) and the follow-up study period (T1), at a 12 weeks interval. Physicians modified the treatment strategy according to the T0 results, and then patients conducted T1. As indicators of glycemic control, the mean glucose levels, glycated hemoglobin A1c (HbA1c), and time in range were measured. As indicators of glycemic variability, standard deviation (SD) and % coefficient variation (%CV) were measured.
Data from 18 patients were analyzed. The mean glucose levels, HbA1c, SD, and %CV improved in T1 compared to T0 ( < 0.05). During T0, the mean glucose level was significantly lower on a day with hemodialysis than on a day without ( < 0.05), and SD and %CV were significantly higher on a day with hemodialysis than on a day without ( < 0.05). After the physicians modified the treatment according to the T0 results, there were no differences in the mean glucose levels, SD, and %CV between days with and without hemodialysis during T1.
Continuous glucose monitoring could be a promising tool for individualizing treatment strategies in patients with diabetes undergoing hemodialysis.
血糖稳定性最近在糖尿病治疗中被认为很重要。低血糖和高血糖在接受血液透析的糖尿病患者中都经常发生。本研究旨在确定连续血糖监测（CGM）对接受血液透析的糖尿病患者血糖控制和血糖变异性稳定的有效性。
纳入2021年11月至2022年5月期间在韩国大田乙支医疗中心接受血液透析≥3个月的18例年龄≥18岁的1型或2型糖尿病患者。患者进行了两次为期 天的CGM：基线研究期（T0）和随访研究期（T1），间隔12周。医生根据T0结果调整治疗策略，然后患者进行T1。作为血糖控制指标，测量了平均血糖水平、糖化血红蛋白A1c（HbA1c）和血糖在目标范围内的时间。作为血糖变异性指标，测量了标准差（SD）和变异系数百分比（%CV）。
分析了18例患者的数据。与T0相比，T1时平均血糖水平、HbA1c、SD和%CV均有所改善（<0.05）。在T0期间，血液透析日的平均血糖水平显著低于非血液透析日（<0.05），血液透析日的SD和%CV显著高于非血液透析日（<0.05）。医生根据T0结果调整治疗后，T1期间血液透析日和非血液透析日的平均血糖水平、SD和%CV无差异。
连续血糖监测可能是一种很有前景的工具，可用于为接受血液透析的糖尿病患者制定个体化治疗策略。
