Associations Between Patient-Reported Outcomes and Glycaemic Exposure in Continuous Glucose Monitoring Users With...

To assess key patient-reported outcomes (PROs) in individuals with insulin-treated diabetes receiving haemodialysis and examine associations between continuous glucose monitoring (CGM) metrics, HbA1c and PROs.

In this cross-sectional study, adults with insulin-treated diabetes receiving haemodialysis and using CGM were recruited. PROs included glucose monitoring satisfaction (GMSS), diabetes distress (DDS-17, PAID), kidney failure-related symptom burden (IPOS-Renal), thirst (Dialysis Thirst Inventory) and hypoglycaemia awareness (Gold score). CGM metrics were defined according to international consensus recommendations. Multivariable regression analyses examined associations between CGM metrics, HbA1c and PROs.

Forty participants were included. CGM satisfaction was high (median GMSS 4.5 [IQR 3.9-4.7]) with low CGM use-related burden. Overall diabetes distress was low (median DDS-17 1.7 [1.3-2.2]), although emotional burden was frequently reported. Kidney failure-related symptom burden was high. Thirst was common, with 65% of participants reporting problematic thirst. CGM metrics were consistently associated with multiple PROs, whereas HbA1c showed fewer associations. Higher time in range (3.9-10.0 mmol/L) was associated with greater CGM satisfaction (total GMSS score; unstandardised coefficient [B] 0.009, p = 0.044), lower regimen-related distress (B - 0.012, p = 0.040) and lower odds of problematic thirst (OR 0.79 per 5% increase, p = 0.021) and intradialytic thirst (OR 0.77, p = 0.017). Higher HbA1c was associated with increased odds of problematic thirst (OR 2.30 per 11 mmol/mol increase, p = 0.014) and nocturnal thirst (OR 1.66, p = 0.040). Most had intact hypoglycaemia awareness (35/40, 87.5%).

In individuals with insulin-treated diabetes receiving haemodialysis, CGM metrics were consistently associated with patient-reported experience, particularly thirst, and may provide clinically relevant insights beyond HbA1c. Further studies should evaluate whether optimising glycaemic exposure translates into improved patient-reported outcomes.