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THE USE OF FLASH GLUCOSE MONITORING REDUCES THE RISK OF HYPOGLYCEMIA IN PEOPLE WITH DIABETES ON MAINTENANCE HEMODIALYSIS
Abstract
Background and Aims
Few prospective studies have examined the clinical accuracy of flash glucose monitoring (FGM) in people with diabetes (DM) on maintenance hemodialysis (HD). Furthermore, in these patients data on the impact of this technology on glycemic control are lacking.
Methods
A 12-week monocentric, pilot study was conducted in 13 DM subjects on HD (11 males; mean age 64±12.6 years; dialysis vintage 2.9±1.4 years). FGM (Freestyle Libre, Abbott) was applied and main traditional glycemic markers (HbA1c and fructosamine) and FGM-derived metrics were evaluated during the study. Paired SMBG-FGM glucose values were analyzed to calculate mean absolute relative difference (MARD).
Results
Overall, the median MARD was 19.2% (IQR, 9.9-29.9). After 12 weeks, a reduction in time below range (TBR) 54-69 mg/dl [2.5% (IQR, 0.2-4.0) vs. 4% (IQR, 1.0-6.5)] and TBR <54 mg/dl [ 0% (IQR, 0-7) vs. 1% (IQR, 0-2)] was observed (Fig.1). The number of hypoglycemic events also improved, from 6 (IQR, 1.5-9.5) to 2.5 (2.0-6.5) events/day after 10 weeks. Conversely, at the end of follow-up, time in range (TIR) [65 (IQR, 45.5-83.5) vs. 65% (IQR, 54-77)], TAR [(23 (11.5-29.5) vs. 22 (10.5-30.5)%)], HbA1c, and fructosamine were not significantly different compared to baseline. In ROC curve analysis, TIR (AUC=0.686;P=0.011) was a better predictor of glucose variability (coefficient of variation >36%) than HbA1c (AUC=0.592; P=0.372).
Conclusions
FGM is a clinically acceptable tool to assess glycemic control in DM on HD. Moreover, it is effective in reducing the time spent in hypoglycemia in this particular population.