Veeranki Vamsidhar, Prasad Narayan
Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India.
World J Diabetes. 2024 Oct 15;15(10):2006-2009. doi: 10.4239/wjd.v15.i10.2006.
In this editorial, we comment on the article by Zhang . Chronic kidney disease (CKD) presents a significant challenge in managing glycemic control, especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation. Conventional markers like glycated haemoglobin (HbA1c) may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction. This comprehensive review discusses the limitations of HbA1c and explores alternative methods, such as continuous glucose monitoring (CGM) in CKD patients. CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c. Key studies demonstrate the utility of CGM in different CKD settings, including hemodialysis and peritoneal dialysis patients, as well as kidney transplant recipients. Despite challenges like sensor accuracy fluctuation, CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo- and hyperglycemia, to which CKD patients are prone. The review also addresses the limitations of CGM in CKD patients, emphasizing the need for further research to optimize its utilization in clinical practice. Altogether, this review advocates for integrating CGM into managing glycemia in CKD patients, highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.
在这篇社论中，我们对张的文章发表评论。慢性肾脏病（CKD）在血糖控制管理方面带来了重大挑战，尤其是在接受透析或肾移植的糖尿病肾病患者中。由于贫血和肾功能不全等因素，糖化血红蛋白（HbA1c）等传统指标可能无法准确反映这些人群的血糖波动情况。这篇全面的综述讨论了HbA1c的局限性，并探索了替代方法，如在CKD患者中进行连续血糖监测（CGM）。CGM作为一种有前景的技术出现，可提供实时或回顾性血糖浓度测量，并克服了HbA1c的局限性。关键研究证明了CGM在不同CKD情况下的实用性，包括血液透析和腹膜透析患者以及肾移植受者。尽管存在传感器准确性波动等挑战，但CGM在监测血糖趋势和降低CKD患者易患的低血糖和高血糖风险方面被证明是有价值的。该综述还讨论了CKD患者中CGM的局限性，强调需要进一步研究以优化其在临床实践中的应用。总之，这篇综述主张将CGM纳入CKD患者的血糖管理中，突出其相对于传统指标的优越性，并敦促临床医生将CGM视为其医疗手段中的一种有价值工具。
