Authors: Jinzhu Li, Ruiqin Zhang, Zhen Wu, Jiayu Guo, Zhiying Wang, Shuhui Li, Chunlin Li, Guang Yang & Xiaoling Cheng
Abstract
Introduction
Patients with diabetes mellitus and end-stage renal disease are at a high risk of developing coronary, cerebrovascular, and peripheral vascular diseases. This study aimed to characterize hypoglycemia and blood glucose fluctuations associated with maintenance hemodialysis in older adult patients with diabetes mellitus and end-stage renal disease using a continuous glucose monitoring system.
Methods
Seven patients were enrolled in this study, and 13 pairs of continuous glucose monitoring system data were collected. Each pair included data of 1 dialysis-on day and 1 dialysis-off day. Information on basic patient characteristics, including age, diabetes mellitus duration, hemodialysis duration, and proportions of hemoglobin A1c and glycated albumin, were collected. Differences in blood glucose fluctuation were compared between dialysis-on days and dialysis-off days.
Results
The mean blood glucose on dialysis-on days (6.96 ± 2.57 mmol/L) was significantly lower than that on dialysis-off days (7.68 ± 2.31 mmol/L; P < 0.05). In contrast, the following parameters had significantly higher values (all P < 0.05) on dialysis-on days compared to dialysis-off days: large amplitude of glycemic excursion level (5.82 ± 2.86 mmol/L versus 4.21 ± 1.71 mmol/L), large amplitude of glycemic excursion level from 8 a.m. to 2 p.m. (3.6 ± 1.74 mmol/L versus 2.8 ± 1.33 mmol/L), mean amplitude of glycemic excursion level (4.78 ± 1.68 mmol/L versus 3.89 ± 1.67 mmol/L), mean amplitude of glycemic excursion level from 8 a.m. to 2 p.m. (4.01 ± 1.03 mmol/L versus 3.12. ± 0.97 mmol/L), standard deviation of blood glucose (1.55 ± 0.89 mmol/L versus 1.03 ± 0.4 mmol/L), and time below a target glucose range of less than 3.9 mmol/L (8.27% versus 4.25%).
Conclusion
Fluctuations in blood glucose levels were larger on dialysis-on days, particularly from the start of hemodialysis to 2 h post-hemodialysis, than on dialysis-off days. Hypoglycemia, as indicated by the time below a target glucose range of less than 3.9 mmol/L, occurred more frequently on dialysis-on days than on dialysis-off days.
Key Summary Points |
Why carry out this study?While it is well established that dialysis can affect blood glucose fluctuations, few studies have evaluated this relationship in older adult patients with diabetes mellitus (DM) and end-stage renal disease (ESRD) on maintenance hemodialysis This study characterized hypoglycemia and blood glucose fluctuations in older adult patients with DM and ESRD on maintenance hemodialysis, with the aim of highlighting the need for clinicians to closely monitor blood glucose status in patients undergoing dialysis |
What was learned from the study?We observed that fluctuations in blood glucose levels were larger on dialysis-on days, particularly from the start of hemodialysis to 2 h post-hemodialysis, than on dialysis-off days; hypoglycemia occurred more frequently on dialysis-on days than on dialysis-off days Our results emphasize the importance of monitoring blood glucose in older adult patients with DM and ESRD on maintenance hemodialysis and provide an evidence base that will facilitate the development of future intervention studies |