Assessing Glycaemic Control in Maintenance Haemodialysis Patients with Type 2 Diabetes
- Sara Kazempour-Ardebili, MD (s.kazempour{at}imperial.ac.uk)1,
- Varunika L Lecamwasam, MRCP2,
- Thushara Dassanyake, BSc2,
- Andrew H Frankel, MD, FRCP2,
- Frederick W. K. Tam, PhD, FRCP2,
- Anne Dornhorst, DM, FRCP3,
- Gary Frost, PhD1 and
- Jeremy J O Turner, DPhil MRCP1
- 1-Department of Investigative Medicine, 6th Floor, Commonwealth Building, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN
- 2-Imperial College Kidney and Transplant Institute, Division of Medicine, Hammersmith Hospital, London, W12 0HS
- 3-Department of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN
Abstract
Objective: Optimising glycaemic control in diabetic patients on maintenance haemodialysis (HD) requires its accurate assessment. We hypothesize that 1) 48-hour continuous glucose monitoring (CGM) provides additional, clinically relevant, information to that provided by the HbA1c measurement and 2) glycaemic profiles differ significantly between day on and day off dialysis.
Research Design and Methods: 48-hour CGM was performed using GlucoDay®S in 19 type 2 diabetic HD subjects capturing consecutive 24-hour periods on and off HD. Energy intake was calculated using food diaries. HbA1c was assayed by an HPLC method.
Results: CGM data was available for 17 subjects (13 male), aged (mean, range) 61.5 yrs (42 - 79) and diabetes duration of 18.8 years (4 - 30). The 24 hour CGM area under the glucose curve and 24-hour mean glucose values were significantly higher during the day off dialysis than on dialysis (5932.1 ± 2673.6 vs. 4694 ± 1988.0mmol.3min.l−1, p=0.022 and 12.6 ± 5.6mmol.L−1 vs. 9.8 ± 3.8mmol.L−1, p=0.013, respectively), independent of energy intake. Asymptomatic hypoglycaemia occurred in 4 subjects, 3 within 24 hours of dialysis and the glucose nadir in 14 subjects occurred within 24 hours of dialysis.
Conclusions: Glucose values are significantly lower on dialysis than non-dialysis days despite similar energy intake. The risk of asymptomatic hypoglycaemia was highest within 24 hours of dialysis. Physicians caring for these patients need to be aware of this phenomenom and consider enhanced glycaemic monitoring following a haemodialysis session. Thus, CGM provides additional glycaemic information to the HbA1c that is potentially relevant to clinical management.
Footnotes
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- Received September 15, 2008.
- Accepted January 16, 2009.
- Copyright © American Diabetes Association
