Interpretation of glycaemic variability in type 2 diabetes mellitus patients on maintenance haemodialysis using continuous glucose monitoring.

BACKGROUND

Diabetes mellitus is the leading cause of end-stage renal disease, accounting for approximately 40% of cases. Data on glycaemic metrics in diabetic population on maintenance haemodialysis is sparse. The role of continuous glucose monitoring in this population remains underexplored.

METHODS

This prospective observational study aimed to comprehensively characterize glycaemic variability using continuous glucose monitoring in patients with type 2 diabetes mellitus undergoing maintenance haemodialysis. 25 patients aged between 18 and 70 years with more than 3 months of dialysis vintage were included in the study. After collecting socio-demographic and clinical data, an ambulatory glucose profile sensor was applied to the patient's upper limb before starting their scheduled dialysis session. Sensors measured the interstitial fluid glucose every 15min, and a total of 96 readings were taken per day, continuously for 14 days (336h).

RESULTS

For statistical analysis, the study population was broadly divided into 2 major groups, one which required insulin for their glycaemic management and the other requiring an oral hypoglycaemic agent, linagliptin. Statistical analysis was performed using SPSS software version 26.0 (IBM Corp., Armonk, NY). In both the groups, glycaemic excursion was observed, with dialysis days having high mean glucose values than non-dialysis days, and the observation was more prominent in the insulin-treated group. The mean glucose levels were lower in the nocturnal period in both the groups. It was noticed that the overall glycaemic variability, glycaemic variability in both dialysis and non-dialysis days were lower in linagliptin-treated group.

CONCLUSION

This study demonstrated significant differences in glycaemic variability based on antidiabetic treatment modality in haemodialysis population. Continuous glucose monitoring is an invaluable tool to study glycaemic metrics and guide therapy in haemodialysis population.