Analysis of Hemodialysis-Associated Hypoglycemia in Patients with Type 2 Diabetes Using a Continuous Glucose Monitoring System

Background: Adequate glycemic control is important for patients with end-stage renal disease on maintenance hemodialysis (HD). Continuous glucose monitoring (CGM) systems are reported as a useful method for glucose monitoring in patients under maintenance HD. The object of this study was to describe glucose profiles and hypoglycemia associated with HD in diabetes patients using a CGM system. Methods: We recruited nine medically stable patients with type 2 diabetes under maintenance HD. CGMS (R) System Gold (R) (Medtronic MiniMed, Northridge, CA) was applied to the subjects for 144 h. During the period, HD using glucose-containing dialysate was performed every other day. Various glucose profiles were calculated from the CGM readings and compared between the day on and the day off dialysis. Results: Mean +/- SD for age, duration of diabetes, and hemoglobin A1c were 67 +/- 9 years, 24 +/- 9 years, and 8.6 +/- 1.2%, respectively. Hemoglobin A1c was correlated with mean glucose (rho = 0.780, P < 0.05) and with area under the curve for glucose above 180 mg/ dL (rho = 0.797, P < 0.05). Although there was no difference for mean amplitude of glycemic excursion between the day on and off HD, hypoglycemia occurred predominantly with day on HD. In the subjects who maintained antidiabetes agents with day on HD, glucose levels decreased with initiation of HD, causing significantly lower glucose levels compared to those during the equivalent time of the following day without HD. Conclusions: According to the CGM system, glucose variability was not affected by HD. However, in spite of glucose-containing dialysate, HD seemed to increase the risk of hypoglycemia.