Unravelling dialysis-related dysglycaemia: Longitudinal insights from continuous glucose monitoring

To characterise CGM-derived glycaemic trajectories over 12months in people receiving maintenance haemodialysis, with a particular focus on hypoglycaemia burden and composite glycaemic risk.

We conducted a longitudinal observational study. CGM data were collected at baseline, 6 and 12 months. Descriptive statistics summarised characteristics. Outcomes included time in range (TIR), time below range (TBR), time above range (TAR), glycaemic variability (GV), hypoglycaemia burden and glycaemic risk index (GRI). Metrics were summarised using means or medians, and changes between timepoints were assessed using paired t-tests or Wilcoxon signed-rank tests.

In 125 participants (mean age 63.7 years; 54.5% men), TIR increased from 51.6% at baseline to 56.6% at 6 months (mean difference 5.09%, 95% CI 1.06 to 9.12; p = 0.014) but was not sustained at 12 months (50.5%; p = 0.568), with a decline between 6 and 12 months (-6.11%, 95% CI -9.03 to -3.19; p < 0.001). TBR remained low, with a small increase between 6 and 12 months (1.61%, 95% CI 0.59-2.64; p = 0.002). TAR and GV were unchanged across timepoints. Hypoglycaemia burden increased over follow-up (p < 0.001), while GRI showed no change. HbA1c showed moderate concordance with CGM-derived glucose at baseline (ρ = 0.39; p = 0.0001) and 12 months (ρ = 0.59; p < 0.0001).

CGM revealed evolving glycaemic patterns. Early improvements in TIR were not sustained, hypoglycaemia increased modestly and the overall GRI remained unchanged. These findings support CGM-informed, individualised diabetes management, prioritising safety and stability.