Hannah Katia L, Nemlekar Poorva M, Johnson Matthew L, Cherñavvsky Daniel R, Norman Gregory J
Global Access, Dexcom, Inc., San Diego, California.
Clinical Affairs, Dexcom, Inc., San Diego, California.
Kidney360. 2024 Apr 1;5(4):515-521. doi: 10.34067/KID.0000000000000396. Epub 2024 Feb 15.
Patients with diabetes and CKD have a heightened risk of glycemic variability, which can lead to severe hypoglycemic or hyperglycemic events, potentially resulting in hospitalization. This study describes the results of a retrospective claims analysis of people with insulin-requiring type 2 diabetes and stage 3–5 CKD who initiated continuous glucose monitoring. Continuous glucose monitoring could help patients with type 2 diabetes and CKD control their glucose and avoid potentially dangerous glycemic events.
There is a heightened risk of glycemic variability in patients with diabetes and CKD. This glycemic variability could lead to hypoglycemic or hyperglycemic crises. We hypothesized that initiation of continuous glucose monitoring (CGM), which provides a glucose measurement every 1–5 minutes, could reduce the incidence of hospitalizations for patients with type 2 diabetes (T2D) and CKD.
A retrospective analysis of US administrative claims data from the Optum Clinformatics database was conducted. People with T2D, using insulin, not receiving dialysis, and living with stage 3–5 CKD who initiated CGM between January 1, 2016, and March 31, 2022, were identified. National Drug Codes and Healthcare Common Coding Procedure System codes were used to identify CGM device use, and International Classification of Diseases 10th revision codes were used to identify CKD diagnosis and categorize health care encounters. Rates of diabetes-related hospitalizations were obtained, and multivariable logistic regression analyses revealed predictors of hypoglycemic and hyperglycemic encounters.
A total of 8,959 insulin-using patients with T2D and CKD were identified. Most were White (72.3%), had Medicare insurance coverage (82.2%), were using intensive insulin (91.3%), and had stage 3 CKD (86.0%). After CGM initiation, rates of hospitalizations for hyperglycemia or hypoglycemia decreased by 18.2% and 17.0%, respectively ( < 0.0001 for both). The proportion hospitalized with at least one hypoglycemic or hyperglycemic event also significantly decreased after CGM initiation. Significant predictors of both hypoglycemic and hyperglycemic encounters included a previous encounter of that type, age 30–59 years and depression (for hypoglycemia), and age 30–49 years and neuropathy (for hyperglycemia). Use of CGM or glucagon-like peptide-1 receptor agonists was significantly protective against hypoglycemic encounters.
Initiation of CGM was associated with significant reductions in diabetes-related hospitalizations among insulin-using individuals with T2D and moderate-to-severe CKD. CGM could help patients with T2D and CKD control their glucose and avoid potentially dangerous glycemic events.
糖尿病和慢性肾脏病患者发生血糖波动的风险更高，这可能导致严重的低血糖或高血糖事件，进而可能导致住院。本研究描述了一项针对开始进行连续血糖监测的胰岛素依赖型2型糖尿病和3 - 5期慢性肾脏病患者的回顾性索赔分析结果。连续血糖监测有助于2型糖尿病和慢性肾脏病患者控制血糖，避免潜在的危险血糖事件。
糖尿病和慢性肾脏病患者发生血糖波动的风险更高。这种血糖波动可能导致低血糖或高血糖危机。我们假设，每1 - 5分钟进行一次血糖测量的连续血糖监测（CGM）的启动，可以降低2型糖尿病（T2D）和慢性肾脏病患者的住院率。
对Optum临床信息数据库中的美国行政索赔数据进行回顾性分析。确定了2016年1月1日至2022年3月31日期间开始使用CGM的T2D患者，这些患者使用胰岛素，未接受透析，患有3 - 5期慢性肾脏病。使用国家药品代码和医疗保健通用编码程序系统代码来识别CGM设备的使用情况，并使用国际疾病分类第10版代码来识别慢性肾脏病诊断和对医疗保健接触进行分类。获得糖尿病相关住院率，并通过多变量逻辑回归分析揭示低血糖和高血糖事件的预测因素。
共识别出8959例使用胰岛素的T2D和慢性肾脏病患者。大多数为白人（72.3%），有医疗保险覆盖（82.2%），使用强化胰岛素（91.3%），患有3期慢性肾脏病（86.0%）。开始使用CGM后，高血糖或低血糖住院率分别下降了18.2%和17.0%（两者均<0.0001）。开始使用CGM后，因至少一次低血糖或高血糖事件住院的比例也显著下降。低血糖和高血糖事件的显著预测因素包括该类型的既往事件、30 - 59岁和抑郁症（针对低血糖），以及30 - 49岁和神经病变（针对高血糖）。使用CGM或胰高血糖素样肽-1受体激动剂对低血糖事件有显著的保护作用。
对于使用胰岛素的T2D和中度至重度慢性肾脏病患者，开始使用CGM与糖尿病相关住院率的显著降低相关。CGM可以帮助T2D和慢性肾脏病患者控制血糖，避免潜在的危险血糖事件。
