"Usefulness of continuous interstitial glucose in diabetic patient undergoing hemodialysis

In patients with type 2 diabetes (T2D) undergoing hemodialysis (HD), glycemic control is challenging, and glycated hemoglobin (HbA1c) is often unreliable due to altered red blood cell turnover, anemia, and treatments such as erythropoiesis-stimulating agents. Continuous glucose monitoring (CGM) provides additional metrics-such as time in range (TIR), time below range (TBR), and glycemic variability-that may better reflect glucose control in this population. This study aimed to assess the usefulness of 14-day CGM data compared to HbA1c in evaluating glycemic control in T2D patients on HD.

This is a prospective and multicenter study. Patients included were of > 18 years, DM2, and hemodialysis patients. We assessed glycemic control of diabetic hemodialysis patient over 14 days with the CGM freestyle 1 comparing to HbA1c.

Forty-one patients were included. While 68 % had HbA1c < 8 %, only 21 % met the CGM targets (P < 0.005). Mean glucose levels were significantly lower on dialysis days (-13 mg/dl, P < 0.0001), without an increase in hypoglycemic episodes. Discrepancies between HbA1c and CGM metrics were associated with diabetes-related nephropathy and longer duration of HD.

HbA1c alone may substantially underestimate glycemic burden in patients on hemodialysis. CGM provides a more accurate assessment of glucose control and reveals undetected hypo- and hyperglucose levels. Incorporating CGM into routine care may improve diabetes management and therapeutic decision-making in this high-risk population.