Glycemic Patterns Revealed by Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Intermittent Hemodialysis: A Pilot Study.

Introduction

Glycemic control in patients with type 2 diabetes mellitus undergoing intermittent hemodialysis represents a clinical challenge. The pathophysiological alterations inherent to chronic kidney disease (CKD) and the dialysis procedure limit the usefulness of traditional metrics. In this context, continuous glucose monitoring (CGM) enables dynamic assessment of glycemic profiles and can reveal patterns of dysglycemia that go undetected in routine clinical practice.

Methods

An observational, cross-sectional, and analytical pilot study involved 10 patients from the hemodialysis (HD) unit. CGM was carried out for 14 days. A paired analysis was performed to compare glycemic parameters on days with and without HD. Statistical evaluation was performed using the Shapiro-Wilk test and Student's t-test; a p-value < 0.05 indicated statistical significance.

Results

Time in range (TIR) showed considerable interindividual variability (24-100%), with hyperglycemia being the predominant factor. During HD sessions, glucose levels showed a marked intradialytic decline followed by incomplete post-dialysis recovery, a pattern that differed from non-dialysis days (paired t-test, p < 0.001; n = 10 paired observations). These findings should be interpreted as exploratory. Hypoglycemic episodes were infrequent, whereas persistent hyperglycemia prevailed.

Conclusions

CGM reveals metabolic dysregulation frequently overlooked by traditional indicators such as glycated hemoglobin (HbA1c). These exploratory findings suggest that CGM may provide clinically relevant information in this population, although larger studies are needed before therapeutic recommendations can be established.