Keywords
chronic kidney disease
peritoneal dialysis
continuous glucose monitoring
glycemic variability
hyperglycemia
hypoglycemia
How to Cite
Abstract
Background: Patients with diabetes mellitus (DM) and diabetic kidney disease (DKD) face increased morbidity and mortality from cardiovascular diseases. Glycemic control is a challenge due to the multiple metabolic variations during dialysis therapy; careful monitoring is key to preventing complications in this population.
Purpose: The objective of this study is to describe the behavior of glycemia determined by continuous glucose monitoring (CGM) in the diabetic kidney population on peritoneal dialysis (PD) therapy, to describe the variables of continuous glucose monitoring and its measurement with the peritoneal dialysis modality, with glucose-based dialysis concentrations, as well as with analytical and nutritional variables.
Methodology: Prospective cohort study. Patients with type 1 and 2 DM and end-stage DKD on PD were included.
Results: 46 patients with chronic kidney disease (CKD) on peritoneal dialysis were included. Median age was 63 years (IQR 54.3-69.8); 65% were male. 93% had type 2 DM, with a median time since diagnosis of 20 years; 76.1% were on continuous ambulatory peritoneal dialysis (CAPD), and 23.9% on automated peritoneal dialysis (APD). Median glycated hemoglobin (HbA1C) was 7.5% (IQR=7-8.3), and median glucose control indicator (GMI) was 7.2% (IQR=6.7-7.6). Median time in range (TIR), time over range (TSR), and time below range (TBR) were 60.5%, 34%, and 0.5%, respectively.
Conclusions: A tendency toward hyperglycemia will be observed in patients undergoing PD, especially in those with dialysis solutions with higher glucose concentrations.
References
Flier JS, Kahn CR. Insulin: a pacesetter for the shape of modern biomedical science and the Nobel Prize. Mol Metab. 2021;52:101194. https://doi.org/10.1016/j.molmet.2021.101194
Oei E, Samad N, Visser A, Chowdhury TA, Fan SL. Use of continuous glucose monitoring in patients with diabetes on peritoneal dialysis: poor correlation with HbA 1c and high incidence of hypoglycaemia. Diabet Med. 2016;33(9):e17-20. https://doi.org/10.1111/dme.12988
Ng JKC, Ling J, Luk AOY, Lau ESH, Ma RCW, Li PKT, et al. Evaluation of a fourth-generation subcutaneous real-time continuous glucose monitor (CGM) in individuals with diabetes on peritoneal dialysis. Diabetes Care. 2023;46(6):1191-5. https://doi.org/10.2337/dc22-2348
Ling J, Ng JKC, Chan JCN, Chow E. Use of continuous glucose monitoring in the assessment and management of patients with diabetes and chronic kidney disease. Front Endocrinol. 2022;13:869899. https://doi.org/10.3389/fendo.2022.869899
Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation. 2021;143(11):1157-72. https://doi.org/10.1161/circulationaha.120.050686
Chen XX, Duan Y, Zhou Y. Effects of hemodialysis and peritoneal dialysis on glycometabolism in patients with end-stage diabetic nephropathy. Blood Purif. 2021;50(4-5):506-12. https://doi.org/10.1159/000511722
Dávila-Ruales V, Gilón LF, Gómez AM, Muñoz OM, Serrano MN, Henao DC. Evaluating the precision and reliability of real-time continuous glucose monitoring systems in ambulatory settings: a systematic review. Ther Adv Endocrinol Metab. 2024;15:20420188241304459. https://doi.org/10.1177/20420188241304459
Jakubowska Z, Malyszko J. Continuous glucose monitoring in people with diabetes and end-stage kidney disease-review of association studies and Evidence-Based discussion. J Nephrol. 2024;37(2):267-79. https://doi.org/10.1007/s40620-023-01802-w
Ólafsdóttir AF, Andelin M, Saeed A, Sofizadeh S, Hamoodi H, Jansson PA, et al. Performance of Dexcom G5 and FreeStyle Libre sensors tested simultaneously in people with type 1 or 2 diabetes and advanced chronic kidney disease. World J Clin Cases. 2022;10(22):7794-807. https://doi.org/10.12998/wjcc.v10.i22.7794
Divani M, Georgianos PI, Didangelos T, Liakopoulos V, Makedou K, Iliadis F, et al. Assessment of hyperglycemia, hypoglycemia and inter-day glucose variability using continuous glucose monitoring among diabetic patients on chronic hemodialysis. J Clin Med. 2021;10(18):4116. https://doi.org/10.3390/jcm10184116
Graham C. Continuous glucose monitoring and global reimbursement: an update. Diabetes Technol Ther. 2017;19(S3):S60-6. https://doi.org/10.1089/dia.2017.0096
Gómez AM, Vallejo S, Ardila F, Muñoz OM, Ruiz ÁJ, Sanabria M, et al. Impact of a basal-bolus insulin regimen on metabolic control and risk of hypoglycemia in patients with diabetes undergoing peritoneal dialysis. J Diabetes Sci Technol. 2018;12(1):129-35. https://doi.org/10.1177/1932296817730376
Battelino T, Alexander CM, Amiel SA, Arreaza-Rubin G, Beck RW, Bergenstal RM, et al. Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol. 2023;11(1):42-57. https://doi.org/10.1016/s2213-8587(22)00319-9
Vaddiraju S, Burgess DJ, Tomazos I, Jain FC, Papadimitrakopoulos F. Technologies for continuous glucose monitoring: current problems and future promises. J Diabetes Sci Technol. 2010;4(6):1540-62. https://doi.org/10.1177/193229681000400632
Kesavadev J, Ramachandran L, Krishnan G. Glucose monitoring technologies - complementary or competitive? Role of continuous glucose monitoring versus flash glucose monitoring versus self-monitoring of blood glucose. J Diabetol. 2017;8(3):61-7. https://doi.org/10.4103/jod.jod_14_17
Chan YH. Biostatistics 104: correlational analysis. Singapore Med J. 2003;44(12):614-9.
Chico A, Aguilera E, Ampudia-Blasco FJ, Bellido V, Cardona-Hernández R, Escalada FJ, et al. Clinical approach to flash glucose monitoring: an expert recommendation. J Diabetes Sci Technol. 2020;14(1):155-64. https://doi.org/10.1177/1932296819841911
Teo E, Hassan N, Tam W, Koh S. Effectiveness of continuous glucose monitoring in maintaining glycaemic control among people with type 1 diabetes mellitus: a systematic review of randomised controlled trials and meta-analysis. Diabetologia. 2022;65(4):604-19. https://doi.org/10.1007/s00125-021-05648-4
Janapala RN, Jayaraj JS, Fathima N, Kashif T, Usman N, Dasari A, et al. Continuous glucose monitoring versus self-monitoring of blood glucose in type 2 diabetes mellitus: a systematic review with meta-analysis. Cureus. 2019;11(9):e5634. https://doi.org/10.7759/cureus.5634
Jancev M, Vissers TACM, Visseren FLJ, van Bon AC, Serné EH, DeVries JH, et al. Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis. Diabetologia. 2024;67(5):798-810. https://doi.org/10.1007/s00125-024-06107-6
García?Moreno RM, Benítez?Valderrama P, Barquiel B, González Pérez?de?Villar N, Hillman N, Lora Pablos D, et al. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta?analysis of randomized clinical trials. Diabet Med. 2022;39(1):e14703. https://doi.org/10.1111/dme.14703
Wright EE, Kerr MSD, Reyes IJ, Nabutovsky Y, Miller E. Use of flash continuous glucose monitoring is associated with a1c reduction in people with type 2 diabetes treated with basal insulin or noninsulin therapy. Diabetes Spectr. 2021;34(2):184-9. https://doi.org/10.2337/ds20-0069
Jiao Y, Lin R, Hua X, Churilov L, Gaca MJ, James S, et al. A systematic review: cost?effectiveness of continuous glucose monitoring compared to self?monitoring of blood glucose in type 1 diabetes. Endocrinol Diabetes Metab. 2022;5(6):e369. https://doi.org/10.1002/edm2.369
Veríssimo D, Pereira BR, Vinhais J, Ivo C, Martins AC, Silva JN, et al. Cost-effectiveness of inpatient continuous glucose monitoring. Cureus. 2024;16(3):e55999. https://doi.org/10.7759/cureus.55999
Pease AJ, Zoungas S, Callander E, Jones TW, Johnson SR, Holmes-Walker DJ, et al. Nationally subsidized continuous glucose monitoring: a cost-effectiveness analysis. Diabetes Care. 2022;45(11):2611-9. https://doi.org/10.2337/dc22-0951
Schwing WD, Erhard P, Newman LN, Nodge MM, Czechanski BJ, Orlin SM, et al. Assessing 24-hour blood glucose patterns in diabetic paitents treated by peritoneal dialysis. Adv Perit Dial. 2004;20:213-6.
Okada E, Oishi D, Sakurada T, Yasuda T, Shibagaki Y. A comparison study of glucose fluctuation during automated peritoneal dialysis and continuous ambulatory peritoneal dialysis. Adv Perit Dial. 2015;31:34-7.
Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019;42(8):1593-603. https://doi.org/10.2337/dci19-0028
Di Molfetta S, Rossi A, Assaloni R, Cherubini V, Consoli A, Di Bartolo P, et al. A guide for the use of LibreView digital diabetes platform in clinical practice: expert paper of the Italian Working Group on Diabetes and Technology. Diabetes Res Clin Pract. 2022;187:109867. https://doi.org/10.1016/j.diabres.2022.109867
Qayyum A, Chowdhury TA, Oei EL, Fan SL. Use of continuous glucose monitoring in patients with diabetes mellitus on peritoneal dialysis: correlation with glycated hemoglobin and detection of high incidence of unaware hypoglycemia. Blood Purif. 2016;41(1-3):18-24. https://doi.org/10.1159/000439242
Lee SY, Chen YC, Tsai IC, Yen CJ, Chueh SN, Chuang HF, et al. Glycosylated hemoglobin and albumin-corrected fructosamine are good indicators for glycemic control in peritoneal dialysis patients. PLoS One. 2013;8(3):e57762. https://doi.org/10.1371/journal.pone.0057762
Marshall J, Jennings P, Scott A, Fluck RJ, Mcintyre CW. Glycemic control in diabetic CAPD patients assessed by continuous glucose monitoring system (CGMS). Kidney Int. 2003;64(4):1480-6. https://doi.org/10.1046/j.1523-1755.2003.00209.x
Afghahi H, Nasic S, Peters B, Rydell H, Hadimeri H, Svensson J. Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis. PLoS One. 2022;17(1):e0262880. https://doi.org/10.1371/journal.pone.0262880
Skubala A, Zywiec J, Ze?obowska K, Gumprecht J, Grzeszczak W. Continuous glucose monitoring system in 72-hour glucose profile assessment in patients with end-stage renal disease on maintenance continuous ambulatory peritoneal dialysis. Med Sci Monit. 2010;16(2):CR75-83.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2025 Revista Colombiana de Endocrinología, Diabetes & Metabolismo