RT Journal Article
SR Electronic
T1 Assessing Glycemic Control in Maintenance Hemodialysis Patients With Type 2 Diabetes
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP 1137
OP 1142
DO 10.2337/dc08-1688
VO 32
IS 7
A1 Kazempour-Ardebili, Sara
A1 Lecamwasam, Varunika L.
A1 Dassanyake, Thushara
A1 Frankel, Andrew H.
A1 Tam, Frederick W.K.
A1 Dornhorst, Anne
A1 Frost, Gary
A1 Turner, Jeremy J.O.
YR 2009
UL http://care.diabetesjournals.org/content/32/7/1137.abstract
AB OBJECTIVE Optimizing glycemic control in diabetic patients undergoing maintenance hemodialysis requires accurate assessment. We hypothesize that 1) 48-h continuous glucose monitoring (CGM) provides additional, clinically relevant, information to that provided by the A1C measurement and 2) glycemic profiles differ significantly between day on and day off dialysis. RESEARCH DESIGN AND METHODS With the use of GlucoDay S, 48-h CGM was performed in 19 type 2 diabetic subjects undergoing hemodialysis to capture consecutive 24-h periods on and off dialysis. Energy intake was calculated using food diaries. A1C was assayed by a high-performance liquid chromatography method. RESULTS CGM data were available for 17 subjects (13 male) with a mean (range) age of 61.5 years (42–79 years) and diabetes duration of 18.8 years (4–30 years). The 24-h CGM area under the glucose curve and 24-h mean glucose values were significantly higher during the day off dialysis than on dialysis (5,932.1 ± 2,673.6 vs. 4,694 ± 1,988.0 mmol · 3 min−1 · l−1, P = 0.022, and 12.6 ± 5.6 vs. 9.8 ± 3.8 mmol/l, P = 0.013, respectively), independent of energy intake. Asymptomatic hypoglycemia occurred in 4 subjects, 3 within 24 h of dialysis, and the glucose nadir in 14 subjects occurred within 24 h of dialysis. CONCLUSIONS Glucose values are significantly lower on dialysis days than on nondialysis days despite similar energy intake. The risk of asymptomatic hypoglycemia was highest within 24 h of dialysis. Physicians caring for patients undergoing hemodialysis need to be aware of this phenomenon and consider enhanced glycemic monitoring after a hemodialysis session. CGM provides glycemic information in addition to A1C, which is potentially relevant to clinical management.