Hemodialysis-Related Glycemic Disarray Proven by Continuous Glucose Monitoring: Glycemic Markers and Hypoglycemia

OBJECTIVE There is a high risk of asymptomatic hypoglycemia associated with hemodialysis (HD) using glucose-free dialysate; therefore, the inclusion of glucose in the dialysate is believed to prevent intradialytic hypoglycemia. However, the exact glycemic fluctuation profiles and frequency of asymptomatic hypoglycemia using dialysates containing >100 mg/dL glucose have not been determined. RESEARCH DESIGN AND METHODS We evaluated the glycemic profiles of 98 type 2 diabetes patients undergoing HD (68 men, HbA1c 6.4±1.2%, glycated albumin 20.8±6.8%) with a dialysate containing 100, 125, or 150 mg/dL glucose using continuous glucose monitoring. RESULTS Sensor glucose level (SGL) showed a sustained decrease during HD, irrespective of the dialysate glucose concentration, and reached a nadir that was lower than the dialysate glucose concentration in 49 participants (50%). Twenty-one participants (21%) presented with HD-related hypoglycemia, defined by an SGL <70 mg/dL during HD and/or between the end of HD and their next meal. All these hypoglycemic episodes were asymptomatic. Measures of glycemic variability calculated using the SGL data (standard deviation, coefficient of variation, and range of SGL) were higher and time below range (<70 mg/dL) was lower in participants who experienced HD-related hypoglycemia than in those who did not, whereas time in range between 70 and 180 mg/dL, time above range (>180 mg/dL), HbA1c and GA of the two groups were similar. CONCLUSIONS Despite the use of dialysate containing 100–150 mg/dL glucose, diabetic HD patients experienced HD-related hypoglycemia unawareness frequently. SGL may fall well below the dialysate glucose concentration toward the end of HD.

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Flash glucose monitoring reduces glycemic variability and hypoglycemia: real-world data from Spain

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-001052 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001052 ◽

Cited By ~ 4

Author(s):

Fernando Gomez-Peralta ◽

Timothy Dunn ◽

Katherine Landuyt ◽

Yongjin Xu ◽

Juan Francisco Merino-Torres

Keyword(s):

Real World ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Real World Data ◽

Flash Glucose Monitoring ◽

Testing Frequency ◽

Scan Rate ◽

Time In Range ◽

Glycemic Markers ◽

Design And Methods

ObjectiveObservations in real-world settings support and extend findings demonstrated in randomized controlled trials that show flash glucose monitoring improves glycemic control. In this study, Spain-specific relationships between testing frequency and glycemic parameters were investigated under real-world settings.Research design and methodsDeidentified glucose and user scanning data were analyzed and readers were rank ordered into 20 equal sized groups by daily scan frequency. Glucose parameters were calculated for each group: estimated HbA1c, time below range (<70 and ≤54 mg/dL), within range (70–180 mg/dL), and above range (>180 mg/dL). Glycemic variability (GV) metrics were described and data obtained from sensors in Spain and worldwide were compared.ResultsSpanish users (n=22 949) collected 37.1 million glucose scans, 250 million automatically recorded glucose readings, and checked glucose values via a mean of 13 scans/day. Estimated HbA1c, time below 70 mg/dL, at or below 54 mg/dL, above 180 mg/dL, and GV metrics were significantly lower in the highest compared with lowest scan rate group (39.6 to 3.9 scans/day). Time-in-range was higher for the highest versus lowest scan rate group at 15.6 vs 11.5 hours/day, respectively. GV metrics correlated positively with time below 70 mg/dL, at or below 54 mg/dL, above 180 mg/dL, and negatively with time-in-range. The relationship between glucose metrics and scan rate was similar in Spain and worldwide. However, time in hypoglycemia in Spain was higher in the groups with lower scan rates.ConclusionsAs seen in clinical trials, flash glucose monitoring in real-world settings allows frequent glucose checks. High scan rates are associated with the favorable glycemic markers of increased time-in-range and reduced time in hyperglycemia and hypoglycemia, and GV. The same trends, with unique nuances, are observed in both Spanish and global data.

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Thresholds of Glycemia and the Outcomes of COVID-19 Complicated With Diabetes: A Retrospective Exploratory Study Using Continuous Glucose Monitoring

10.2337/figshare.13636796.v1 ◽

2021 ◽

Author(s):

Yun Shen ◽

Xiaohong Fan ◽

Lei Zhang ◽

Yaxin Wang ◽

Cheng Li ◽

...

Keyword(s):

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Adverse Outcomes ◽

Glucose Levels ◽

Increased Risk ◽

Patients With Diabetes ◽

Sensor Glucose ◽

Elevated Glucose ◽

Time In Range ◽

Design And Methods

Objective: Although elevated glucose levels are reported to be associated with adverse outcomes of coronavirus disease 2019 (COVID-19), the optimal range of glucose in patients with COVID-19 and diabetes remains unknown. This study aimed to investigate the threshold of glycemia and its association with the outcomes of COVID-19. Research design and methods: Glucose levels were assessed via intermittently scanned continuous glucose monitoring in 35 patients with an average period of 10.2 days. The percentages of time above range (TAR), time below range (TBR), time in range (TIR), and coefficient of variation (CV) were calculated. Composite adverse outcomes were defined as either the need for admission to intensive care unit, need for mechanic ventilation, or morbidity with critical illness. Results: TARs with the threshold from 160 mg/dL - 200 mg/dL were all significantly associated with composite adverse outcomes after adjustment of covariates. Both TBR (<70 mg/dL) and TIR of 70 mg/dL - 160 mg/dL, but not mean sensor glucose level, were significantly associated with composite adverse outcomes and prolonged hospitalization. The multivariate-adjusted odds ratios of the CV of sensor glucose across its tertiles for composite adverse outcomes of COVID-19 were 1.00, 1.18, and 25.2, respectively. Conclusions: Patients with diabetes and COVID-19 have an increased risk of adverse outcomes with glucose levels over 160 mg/dL, below 70 mg/dL, and a high CV. Therapies that improve these metrics of glycemic control may result in better prognoses for these patients.

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Thresholds of Glycemia and the Outcomes of COVID-19 Complicated With Diabetes: A Retrospective Exploratory Study Using Continuous Glucose Monitoring

10.2337/figshare.13636796 ◽

2021 ◽

Author(s):

Yun Shen ◽

Xiaohong Fan ◽

Lei Zhang ◽

Yaxin Wang ◽

Cheng Li ◽

...

Keyword(s):

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Adverse Outcomes ◽

Glucose Levels ◽

Increased Risk ◽

Patients With Diabetes ◽

Sensor Glucose ◽

Elevated Glucose ◽

Time In Range ◽

Design And Methods

Objective: Although elevated glucose levels are reported to be associated with adverse outcomes of coronavirus disease 2019 (COVID-19), the optimal range of glucose in patients with COVID-19 and diabetes remains unknown. This study aimed to investigate the threshold of glycemia and its association with the outcomes of COVID-19. Research design and methods: Glucose levels were assessed via intermittently scanned continuous glucose monitoring in 35 patients with an average period of 10.2 days. The percentages of time above range (TAR), time below range (TBR), time in range (TIR), and coefficient of variation (CV) were calculated. Composite adverse outcomes were defined as either the need for admission to intensive care unit, need for mechanic ventilation, or morbidity with critical illness. Results: TARs with the threshold from 160 mg/dL - 200 mg/dL were all significantly associated with composite adverse outcomes after adjustment of covariates. Both TBR (<70 mg/dL) and TIR of 70 mg/dL - 160 mg/dL, but not mean sensor glucose level, were significantly associated with composite adverse outcomes and prolonged hospitalization. The multivariate-adjusted odds ratios of the CV of sensor glucose across its tertiles for composite adverse outcomes of COVID-19 were 1.00, 1.18, and 25.2, respectively. Conclusions: Patients with diabetes and COVID-19 have an increased risk of adverse outcomes with glucose levels over 160 mg/dL, below 70 mg/dL, and a high CV. Therapies that improve these metrics of glycemic control may result in better prognoses for these patients.

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Enlarged glycemic variability in sulfonylurea-treated well-controlled type 2 diabetics identified using continuous glucose monitoring

Scientific Reports ◽

10.1038/s41598-021-83999-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Fumi Uemura ◽

Yosuke Okada ◽

Keiichi Torimoto ◽

Yoshiya Tanaka

Keyword(s):

Glucose Level ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glycemic Variability ◽

High Dose ◽

Type 2 Diabetics ◽

Time In Range ◽

The Difference ◽

Glycated Hemoglobin Level

AbstractTime in range (TIR) is an index of glycemic control obtained from continuous glucose monitoring (CGM). The aim was to compare the glycemic variability of treatment with sulfonylureas (SUs) in type 2 diabetes mellitus (T2DM) with well-controlled glucose level (TIR > 70%). The study subjects were 123 patients selected T2DM who underwent CGM more than 24 h on admission without changing treatment. The primary endpoint was the difference in glycemic variability, while the secondary endpoint was the difference in time below range < 54 mg/dL; TBR < 54, between the SU (n = 63) and non-SU (n = 60) groups. The standard deviation, percentage coefficient of variation (%CV), and maximum glucose level were higher in the SU group than in the non-SU group, and TBR < 54 was longer in the high-dose SU patients. SU treatment was identified as a significant factor that affected %CV (β: 2.678, p = 0.034). High-dose SU use contributed to prolonged TBR < 54 (β: 0.487, p = 0.028). Our study identified enlarged glycemic variability in sulfonylurea-treated well-controlled T2DM patients and high-dose SU use was associated with TBR < 54. The results highlight the need for careful adjustment of the SU dose, irrespective of glycated hemoglobin level or TIR value.

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