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Kidney Week

Abstract: SA-PO458

Efficacy of Continuous Glucose Monitoring (CGM) in People with Diabetes on Dialysis

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Zhang, Yimeng, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Singh, Pushpa, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Krishnasamy Ganapathy, Kavitha Dhevi, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Suresh, Vijayan, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Karamat, Muhammad Ali, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Bellary, Srikanth, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Baharani, Jyoti B., University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
Background

Patients with diabetes on dialysis (DM) experience wide variations in glucose levels leading to increased risk of hypoglycaemia. Due to the inaccuracies of HbA1c in dialysis patients, JBDS-IP and KDIGO Diabetes Work Group recommend the use of CGM. We conducted a systematic review to examine current evidence for CGM use and its impact on clinical outcomes.

Methods

Search of MEDLINE and Embase databases was conducted. Clinical or observational trials in adults with DM on dialysis and CGM intervention reporting glycaemic outcomes were included. Data collected included patient characteristics, intervention and glycaemic outcome. Quality was evaluated using the NHLBI assessment tool.

Results

Of the 936 citations identified, 49 duplicates were removed. 887 screened by title and abstract. 9 full texts reviewed and a further 7 excluded due to duplications and failure to meet to selection criteria. Data was extracted for 2 studies (table 1), both ‘good’ quality, prospective before-and-after interventional studies with no control group.
Joubert et al, (2015) showed mean CGM glucose level was 8.3 at baseline and 7.7mmol/L at the end of the CGM period (p<0.05). HbA1c decreased from 6.9 to 6.5% at the end of 12 weeks (p<0.05). Number of insulin adjustment was higher during the CGM compared to the SMBG period (2.1 vs 1.4, p<0.05). Mean CGM was lower on dialysis days (7.6 vs 7.8mmol/L, p<0.05).
Képénékian et al, (2014) reported after 3 months with CGM-adapted insulin regimen, HbA1c decreased from 8.4 to 7.6% (p<0.01). Mean CGM values decreased from 9.9 to 8.9mmol/L (p=0.05). The frequency of glucose values >10mmol/L decreased from 41 to 30% (p<0.05), without significant increase in hypoglycaemia frequency. Insulin requirements increased from 70 to 82IU/d (p<0.01), without significant weight gain.

Conclusion

Evidence demonstrating impact of CGM on glycaemic outcomes in patients with DM on dialysis is lacking. Further trials with bigger sample size and longer follow up are needed to ascertain the benefits of CGM in these patients.