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Kidney Week

Abstract: PO0998

Continuous Glucose Monitoring in a Diabetic Hemodialysis Patient

Session Information

Category: Trainee Case Report

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Park, Elisa, University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • You, Amy Seung, University of California Irvine, Irvine, California, United States
  • Price, David A., DexCom Inc, San Diego, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
Introduction

Diabetes is the leading cause of end stage renal disease (ESRD) in the US. Patients with diabetic kidney disease (DKD) are susceptible to hypo- and hyperglycemia via multiple pathways. Continuous glucose monitoring (CGM) provides automated, less invasive glucose measurements (updated every 5 minutes) and more comprehensive glucose data vs. conventional self-monitored blood glucose (SMBG), and glycemic benefits for CGM use have been established. However, CGM use has been limited in diabetic hemodialysis (HD) patients as devices are not currently approved for use in this population.

Case Description

We describe a 48-year old male with ESRD due to DKD receiving HD. At the age of 26, the patient was diagnosed with diabetes after presenting with recurrent skin infections and unexplained weight loss. He was initially treated with glyburide which was changed to metformin, and was later transitioned to an insulin pump. Over time he developed DKD which progressed to ESRD by the time he was 41 years old. His diabetes was also complicated by neuropathy and retinopathy with right-eye blindness. For two decades, the patient utilized SMBG with capillary fingerstick measurements to monitor his glycemic status. During this time he had wide fluctuations in his glucose levels with asymptomatic hypo- and hyperglycemia, and his HbA1c levels were typically 10-12%. Due to poor glucose control, his endocrinologist advised him to use CGM (Dexcom G5, later transitioned to Dexcom G6, San Diego, CA). Since transitioning to CGM, the patient reports 1) greater adherence to glycemic monitoring, 2) improved hypoglycemia detection, 3) minimal lifestyle interruption, and 4) improved quality of life. In addition, he has less glycemic variability, increased time-in-target glucose range, and improved HbA1c levels to 6-8%.

Discussion

This case demonstrates CGM is a practical method for glucose assessment with the potential to improve glycemic control in diabetic ESRD patients. Further studies are needed to determine the comparative effectiveness of CGM vs. SMBG in diabetic HD patients.