Kezić Aleksandra, Gajić Selena, Ostojić Ana Račić, Bekić Ivana, Bontić Ana, Pavlović Jelena, Baralić Marko, Popović Ljiljana
Clinic of Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia.
Life (Basel). 2025 May 17;15(5):798. doi: 10.3390/life15050798.
Optimized glycemic management is crucial for controlling atherosclerosis and consequent cardiovascular morbidity in patients with diabetes. Due to the continuous glucose burden from glucose-containing peritoneal dialysis (PD) solutions, PD patients with diabetes experience difficulties in glucose level regulation with glucose hypervariability and worsening dyslipidemia. Even in non-diabetic PD patients, glucose-containing PD solutions aggravate insulin resistance and cause overweight. Additionally, glucose degradation products (GDP) from glucose-based PD solutions provoke oxidative stress and complex inflammatory processes, leading to chronic deleterious and fibrotic peritoneal membrane changes. In this narrative review, we searched the literature using PubMed, MEDLINE, and Google Scholar over the last three decades to summarize the most important facts relevant to the presented issues, aiming to inform both endocrinologists and nephrologists in providing the best currently available care for people with diabetes on PD. We not only focus on adequate tailoring of insulin therapy adapted at the time of PD exchange with hypertonic glucose solution., but also emphasize the use of continuous glucose monitoring (CGM) that allows assessment of mean glucose values and time spent in normal, hypo, and hyperglycemia. However, the routine use of CGM in PD patients is limited due to high cost, and hemoglobin A1c (HbA1c) analysis is still recommended as a basic clinical tool for the assessment of glycemic control. Possible choices of antidiabetic drugs were considered given the narrowed choice due to contraindications for metformin and sulfonylurea. The other important therapeutic approach in PD patients with diabetes is using glucose-sparing PD regimens based on icodextrin and amino acid PD solutions with the addition of just one or two bags of low glucose concentration PD solution daily. This glucose-sparing approach not only reduces the glucose load and improves glycoregulation with correction of the lipid profile but also maintains the viability of the peritoneal membrane by reducing the harmful effects of GDPs.
优化血糖管理对于控制糖尿病患者的动脉粥样硬化及随之而来的心血管疾病发病率至关重要。由于含葡萄糖的腹膜透析（PD）液会持续带来葡萄糖负荷，糖尿病PD患者在调节血糖水平方面存在困难，血糖变异性高，血脂异常也会恶化。即使在非糖尿病PD患者中，含葡萄糖的PD液也会加重胰岛素抵抗并导致超重。此外，基于葡萄糖的PD液中的葡萄糖降解产物（GDP）会引发氧化应激和复杂的炎症过程，导致慢性有害和纤维化的腹膜变化。在这篇叙述性综述中，我们在过去三十年里通过PubMed、MEDLINE和谷歌学术搜索文献，总结与上述问题相关的最重要事实，旨在为内分泌科医生和肾病科医生提供信息，以便为接受PD治疗的糖尿病患者提供目前最佳的护理。我们不仅关注在使用高渗葡萄糖溶液进行PD置换时对胰岛素治疗进行适当调整，还强调使用连续血糖监测（CGM），它可以评估平均血糖值以及在正常、低血糖和高血糖状态下所花费的时间。然而，由于成本高昂，CGM在PD患者中的常规使用受到限制，糖化血红蛋白（HbA1c）分析仍然被推荐作为评估血糖控制的基本临床工具。考虑到二甲双胍和磺脲类药物存在禁忌证，可供选择的抗糖尿病药物范围变窄，我们探讨了可能的选择。糖尿病PD患者的另一种重要治疗方法是使用基于艾考糊精和氨基酸PD液的节糖PD方案，每天仅额外添加一或两袋低葡萄糖浓度的PD液。这种节糖方法不仅减少了葡萄糖负荷，通过改善脂质谱来改善血糖调节，还通过减少GDP的有害影响来维持腹膜的活力。
