Background and Aims

Background: There are limited data on CGM patterns among people with diabetes treated by chronic hemodialysis, particularly using newer Dexcom G6 systems.

Methods

Methods: Prospective observational study of people (> 18 years), with insulin-treated, type 2 diabetes, receiving chronic hemodialysis at Emory’s kidney centers. Patients wore a Dexcom G6 Pro for 10 days. Outcomes of interest included mean CGM glucose, time-in-range (TIR), above (TAR) and below (TBR) range, and rates of overall hypoglycemia (lasting for at least 15 min), nocturnal (from 22-06hrs) and prolonged (lasting for at least 120 min).

Results

Results: Among 34 patients (mean age 57.5±10, 55% females), mean daily CGM glucose was 189± 47 mg/dl, TIR 52±26.7%, TAR > 180 mg/dl 47±28%, TAR > 250 mg/dl 30±22%, TBR 1.2±2.4%, and HbA1c 7.1±1.5%.

Hypoglycemic episodes < 70 and < 54 mg/dl occurred in 56% and 26% of patients, respectively; with nocturnal hypoglycemia occurring in 29% and 8.8% of subjects, respectively. Prolonged hypoglycemia < 70 mg/dl and < 54 mg/dl occurred in 8.8% of subjects. During 10 days, subjects with hypoglycemia < 70 mg/dl, had a mean of 3.7±4 episodes overall, 3.2±4.3 nocturnal episodes, and 2.6±1.8 episodes of < 54 mg/dl. Up to 71% of patients had >5% CGM time in > 250 mg/dl.

Conclusions

Conclusion: People with diabetes on chronic hemodialysis are exposed to large glycemic excursions, with tendency to persistent hyperglycemia, and less frequent -yet common- hypoglycemic episodes. There is a critical need for future interventional studies assessing better glycemic efficacy and safety in this population.