It is inaccurate to assess blood glucose with glycated haemoglobin (HbA1c) in patients with chronic kidney disease and diabetes, also glycated albumin is ineffective to assess Time in Range (TIR) and Glycaemic Variability, emerging cardiovascular risks.
To evaluate glycaemic variability in Haemodialyzed Diabetic Patients we have used Glycaemic Holter (Medtronic Guardian Connect) in 81 Haemodialyzed Diabetic Patients, M 59, F 22, age 66,1 ± 9,5 ys, Diabetes Duration 21,7 ± 11,3 ys, T1DM 3 pts, T2DM 80 pts, Haemodialysis Duration 4,1 ± 3,4 ys, Haemodialysis 43,8%, Haemodialysis lfiltration 53,4%, Acetate-free biofiltration 2,7%, BMI 28,3 ±5,5 Kg/m2, HbA1c 7,2 ±1,36%, Hypertension 89,9%, Dyslipidaemia 60,7%, Heart Disease 29,1%, Stroke 7,59%, Diabetic Foot 26,5%, with amputation 6,5%, Peripheral Arterial Disease 35,4%, Retinopathy 52%. Insulin-Treated Patients 97%.
Median data during 6 registration days were TIR 63%, Time Above Range TAR 33%, Time Below Range TBR 3%, calculated HbA1c 7±0.0%, first dialysis day TIR 82±20%, dialysis day interstitial glucose average 149±35mg/dl, non dialysis day interstitial glucose average 131mg/dl, pre dialysis interstitial glucose average 150±47 mg/dl, post dialysis interstitial glucose average126±38 mg/dl.
Our data demonstrate a moderate/good glucose control and confirm the burnt out of diabetes in dialysis. The observed trend was contrary to expectations with low TBR and higher TAR, without difference between dialysis days e non dialysis days, with the exception of lower interstitial glucose after dialysis. The work is in progress and we hope that new data will be able to help us to improve global treatment of these frail patients.