Can the Use of Continuous Glucose Monitoring Improve Glycemic Control in Patients with Type 1 and 2 Diabetes Receiving Dialysis?
Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
Background: Hemoglobin A1c (HbA1c) is an unreliable glycemic marker in the dialysis population, and alternative methods of glycemic monitoring should be considered. Continuous glucose monitoring (CGM) measures interstitial glucose, an indirect measure of plasma glucose, and allows for estimating mean sensor glucose, glucose variability, and time in ranges. Thus, CGM provides a more nuanced picture of glycemic variables than HbA1c, which only informs about average glucose and not variation in glucose or hypoglycemia. Summary: In non-dialysis patients with type 1 and type 2 diabetes, CGM metrics are increasingly used to estimate glycemic control and are associated with improvements in glucose levels. Although a clear link has not yet been established between some CGM variables and the development of late diabetic complications, CGM use could be an important step forward in improving glycemic control in patients receiving dialysis. The ability to detect and prevent hypoglycemia while optimizing glucose levels could be particularly valuable. However, long-term CGM use has not been evaluated in the dialysis population, and the practical burden and cost associated with CGM use may be a limitation. We discuss the strengths and limitations of using CGM in the dialysis population with type 1 and type 2 diabetes. Key Messages:CGM circumvents the pitfalls of HbA1c in dialysis patients and provides detailed measures of the mean sensor glucose, glucose variability, and time in ranges. Guidelines recommend a minimum of 50% time spent in the target range (3.9-10.0 mmol/L) and less than 1% below range (<3.9 mmol/L) for patients receiving dialysis but remain to be evaluated in the dialysis population. CGM can be a valuable tool in reducing overall glucose levels and variations while detecting hypoglycemia, but the practical burden of CGM use and cost may be a limitation.
|Udgivet - 2023
P.R. received funding for his institution from AstraZeneca for participating in the steering committee for DAPA-CKD. He has received funding to his institution for advisory boards from AstraZeneca, Sanofi Aventis, and Boehringer Ingelheim; from Bayer, Gilead, and Novo Nordisk for steering committees; from Novo Nordisk, Bayer, and Eli Lilly for lectures; and has received grants from Novo Nordisk. K.N. received funding for her institution for participating in advisory boards from Medtronic and Novo Nordisk and for lecturing from Sanofi, Novo Nordisk, Medtronic, and Dexcom. Her institution received funding for studies she performed from Zealand Pharma, RSP Systems, Novo Nordisk, Medtronic, and Dexcom. M.H. received funding for participating in advisory boards from Bayer and AstraZeneca. Remaining authors declare no conflict of interest.
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