ADEQUACY OF GLYCEMIC CONTROL IN DIABETIC DIALYSIS PATIENTS - A SINGLE CENTRE PROSPECTIVE OBSERVATIONAL STUDY USING CONTINUOUS GLUCOSE MONITORING.
Aim: to evaluate diabetic dialysis patients for periods of asymptomatic hypoglycaemia and to compare interstitial glucose readings with HbA1C levels in these individuals.
Background: Most international guidelines recommend targeting HbA1c of <7% irrespective of the presence of chronic kidney disease. However, the correlation of HbA1c with glycaemic control in dialysis patients is contentious due to shortened red cell survival, frequent blood transfusions, iron deficiency and use of erythropoietins. Paradoxically, a large retrospective analysis of diabetic dialysis patients has shown worse outcomes in dialysis patients with HbA1c <5%. Interstitial glucose measurements using Continuous Glucose Monitors(CGM) correlates well with blood glucose using a glucometer even in dialysis patients. Hence, Continuous Glucose Monitoring can identify periods of significant hypoglycaemia in dialysis patients.
7>Method: This is a single center observational study, conducted on all in-center diabetic dialysis patients. CGM was applied to each patient for a total of 6 days continuously. Patients underwent routine dialysis and kept a diary to record their food intake and episodes of hypoglycaemia. HbA1c was measured along with routine monthly dialysis bloods on each patient.
Results: There were no episodes of asymptomatic hypoglycemia in the study patients. There appeared to be better correlation between regular venous blood sugar reading than with HbA1C.
Conclusion: Asymptomatic hypoglycemia does not appear to be a factor in this small study. Regular blood sugar monitoring may be better marker for adequacy of glycemic control than HbA1C, in diabetic haemodialysis patients.