Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Study Protocol
2.3. Study Evaluations
2.3.1. Continuous Glucose Monitoring
2.3.2. Measurement of Glycemic Biomarkers
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of Study Participants
3.2. Accuracy of GA and HbA1c in Assessing Hyper- and Hypo-Glycemia
3.3. Glucose Variability during the Dialysis-On and Dialysis-Off Days
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | Overall | 7-Day TIR70–180 in ≥50% of Readings | 7-Day TIR70–180 in <50% of Readings | p Value |
---|---|---|---|---|
Number of patients | 37 | 26 | 11 | - |
Age (years) | 62.0 ± 17.3 | 64.7 ± 16.6 | 55.6 ± 17.8 | 0.16 |
Male gender (n, %) | 20 (54.1%) | 14 (53.8%) | 6 (54.5%) | >0.90 |
BMI (kg/m2) | 26.8 ± 4.1 | 26.2 ± 2.7 | 28.5 ± 6.2 | 0.11 |
Dialysis vintage (months) | 27 (3, 160) | 27 (3, 120) | 24 (3, 160) | 0.57 |
History of hypertension (n, %) | 37 (100%) | 26 (100%) | 11 (100%) | - |
History of dyslipidemia (n, %) | 26 (70.3%) | 17 (65.4%) | 9 (81.8%) | 0.44 |
History of CAD (n, %) | 23 (62.2%) | 16 (61.5%) | 7 (63.6%) | >0.90 |
History of CHF (n, %) | 17 (45.9%) | 14 (53.8%) | (3 (27.3%) | 0.17 |
Hemoglobin (g/dL) | 10.9 ± 1.2 | 11.0 ± 1.1 | 10.7 ± 1.5 | 0.49 |
Predialysis urea (mg/dL) | 139.6 ± 32.2 | 146.3 ± 33.1 | 124.0 ± 24.7 | <0.05 |
Predialysis creatinine (mg/dL) | 7.1 ± 2.7 | 7.4 ± 2.7 | 6.4 ± 2.6 | 0.33 |
Predialysis glucose (mg/dL) | 164.2 ± 67.4 | 149.4 ± 39.8 | 199.2 ± 102.3 | <0.05 |
Serum albumin (g/dL) | 3.9 ± 0.5 | 3.9 ± 0.5 | 4.0 ± 0.3 | 0.61 |
HbA1c (%) | 6.5 ± 1.4 | 6.3 ± 1.4 | 7.1 ± 1.3 | 0.10 |
Glycated albumin (%) | 17.1 ± 5.2 | 15.0 ± 4.1 | 21.9 ± 4.6 | <0.001 |
Mean 7-day CGM-derived glucose (mg/dL) | 162.1 ± 38.1 | 148.9 ± 24.4 | 193.3 ± 47.1 | <0.001 |
7-day CGM-derived CV (%) | 29.5 ± 6.5 | 28.5 ± 6.8 | 31.9 ± 5.0 | 0.09 |
7-day CGM-derived TIR70–180 (% of readings) | 64.5 ± 21.5 | 74.9 ± 15.5 | 39.7 ± 10.0 | <0.001 |
7-day CGM-derived TBR<70 (% of readings) | 3.6 (0, 65.8) | 2.5 (0, 17.4) | 6.4 (0, 65.8) | 0.33 |
7-day CGM-derived TAR>250 (% of readings) | 9.2 (0, 52.1) | 4.0 (0, 27.6) | 21.3 (0, 52.1) | <0.001 |
Insulin therapy (n, %) | 37 (100%) | 26 (100%) | 11 (100%) | - |
Oral anti-diabetic medication use (n, %) | 0 (0%) | 0 (0%) | 0 (0%) | - |
TIR70–180 < 50% | TAR>250 > 10% | |||||
---|---|---|---|---|---|---|
Parameter | GA | HbA1c | GA | HbA1c | GA | HbA1c |
Area under ROC curve | 0.878 | 0.682 | 0.939 | 0.854 | 0.712 | 0.74 |
(95% CI) | (0.728–0.962) | (0.508–0.825) | (0.808–0.991) | (0.699–0.948) | (0.539–0.848) | (0.570–0.870) |
Youden index (diagnostic efficiency) | 0.793 | 0.433 | 0.791 | 0.631 | 0.429 | 0.471 |
Threshold (%) | >18.96 | >6.29 | >16.27 | >6.29 | ≤18.5 | ≤6.3 |
Sensitivity (%) | 90.9 | 81.8 | 100 | 92.3 | 84.6 | 84.6 |
Parameter | Dialysis-On Day | Dialysis-Off Day | p Value |
---|---|---|---|
Mean 24 h glucose (mg/dL) | 159.2 ± 39.6 | 162.4 ± 47.0 | 0.39 |
24 h CGM-derived CV (%) | 39.2 ± 17.3 | 32.0 ± 7.8 | <0.001 |
24 h CGM-derived TBR<70 (% of readings) | 5.6 (0, 25.8) | 2.8 (0, 17.9) | <0.001 |
24 h CGM-derived TIR70–180 (% of readings) | 62.2 ± 22.3 | 65.2 ± 27.5 | 0.21 |
24 h CGM-derived TAR>250 (% of readings) | 9.1 (0, 52.4) | 9.4 (0, 55.5) | 0.63 |
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Divani, M.; Georgianos, P.I.; Didangelos, T.; Liakopoulos, V.; Makedou, K.; Iliadis, F.; Savopoulos, C.; Grekas, D.M. Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis. J. Clin. Med. 2021, 10, 4116. https://doi.org/10.3390/jcm10184116
Divani M, Georgianos PI, Didangelos T, Liakopoulos V, Makedou K, Iliadis F, Savopoulos C, Grekas DM. Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis. Journal of Clinical Medicine. 2021; 10(18):4116. https://doi.org/10.3390/jcm10184116
Chicago/Turabian StyleDivani, Maria, Panagiotis I. Georgianos, Triantafyllos Didangelos, Vassilios Liakopoulos, Kali Makedou, Fotios Iliadis, Christos Savopoulos, and Dimitrios M. Grekas. 2021. "Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis" Journal of Clinical Medicine 10, no. 18: 4116. https://doi.org/10.3390/jcm10184116
APA StyleDivani, M., Georgianos, P. I., Didangelos, T., Liakopoulos, V., Makedou, K., Iliadis, F., Savopoulos, C., & Grekas, D. M. (2021). Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis. Journal of Clinical Medicine, 10(18), 4116. https://doi.org/10.3390/jcm10184116