Habte-Asres Hellena Hailu, Suglo Joseph Ngmenesegre, Chaudhry Khuram, Forbes Angus, Wheeler David C, Karalliedde Janaka
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
St Pancras Kidney Diabetes and Eye Centre, Royal Free London NHS Foundation Trust, London, UK.
J Diabetes Sci Technol. 2025 Sep 2:19322968251353811. doi: 10.1177/19322968251353811.
This review aims to map the existing literature on the use of diabetes technology in people receiving dialysis, with a focus on utilization, accuracy, and effectiveness.
A scoping review was conducted using the Joanna Briggs Institute methodology, with systematic searches of Medline, Embase, and CINAHL for studies on diabetes technologies in dialysis populations.
The search identified 1060 continuous glucose monitoring (CGM) and 1467 continuous subcutaneous insulin infusion or automated insulin delivery (CSII/AID) records, with 64 studies included. Eighteen studies assessed CGM accuracy, reporting mean absolute relative difference (MARD) values ranging from 8.1% to 29%, with over 97% of readings falling within Clarke error grid zones A or B. Thirteen studies compared glycemic markers, finding that HbA underestimated glucose by 7.3 mmol/mol, while glycated albumin showed a stronger correlation (r = 0.508). Four studies reported on dialysis effects, showing that people on automated peritoneal dialysis (APD) had lower mean glucose levels (181 ± 64 mg/dL) compared to continuous ambulatory peritoneal dialysis (CAPD) (238 ± 67 mg/dL; < .05). Eleven studies evaluating diabetes treatment efficacy using CGM found that dulaglutide significantly reduced glucose CV from 28.1% to 19.8% ( = .003). Twenty-two studies examining glycemic outcomes reported that TIR was lower on dialysis days (80.2%, = .02). Finally, four AID studies reported TIR improvements of up to 37.6% and a 1.5 mmol/L reduction in glucose ( = .003).
This review highlights the potential of CGM and AID to improve diabetes outcomes in people on dialysis. While their clinical utility is evident, broader access and further research are needed to optimize their use in this high-risk population.
本综述旨在梳理有关糖尿病技术在接受透析治疗人群中的应用的现有文献，重点关注其利用率、准确性和有效性。
采用乔安娜·布里格斯研究所的方法进行范围综述，通过对医学数据库（Medline）、荷兰医学文摘数据库（Embase）和护理学与健康领域数据库（CINAHL）进行系统检索，查找有关透析人群中糖尿病技术的研究。
检索共识别出1060条连续血糖监测（CGM）记录和1467条持续皮下胰岛素输注或自动胰岛素给药（CSII/AID）记录，纳入64项研究。18项研究评估了CGM的准确性，报告的平均绝对相对差异（MARD）值在8.1%至29%之间，超过97%的读数落在克拉克误差网格的A区或B区。13项研究比较了血糖标志物，发现糖化血红蛋白（HbA）对血糖的低估程度为7.3 mmol/mol，而糖化白蛋白显示出更强的相关性（r = 0.508）。4项研究报告了透析的影响，表明接受自动化腹膜透析（APD）的患者平均血糖水平（181±64 mg/dL）低于持续性非卧床腹膜透析（CAPD）患者（238±67 mg/dL；P<0.05）。11项使用CGM评估糖尿病治疗效果的研究发现，度拉糖肽可使血糖变异系数（CV）从28.1%显著降至19.8%（P = 0.003）。22项研究血糖结果的研究报告称，透析日的血糖目标范围内时间（TIR）较低（80.2%，P = 0.02）。最后，4项AID研究报告TIR改善高达37.6%，血糖降低1.5 mmol/L（P = 0.003）。
本综述强调了CGM和AID在改善透析患者糖尿病结局方面的潜力。虽然它们的临床效用明显，但需要更广泛的应用和进一步研究，以优化其在这一高危人群中的使用。
