Continuous glucose monitoring in hemodialyzed patients with type 2 diabetes: a multicenter pilot study

Aims: Hemodialyzed patients with diabetes face an increased cardiovascular risk. Optimal glycemic control can reduce morbidity and mortality, but it is difficult to achieve because of the alternation between dialysis and non-dialysis periods. This study evaluated the contribution of continuous glucose monitoring (CGM) to the management of insulin regimen. Methods: In this pilot prospective multicenter study, we performed CGM (Navigator (R), Abbott, Rungis, France) for a total of 54 hours at baseline and for a 3-month follow-up period in a group of 28 hemodialyzed patients with type 2 diabetes treated by a basal-bolus detemir plus aspart insulin regimen. Insulin therapy was adapted to the CGM values. HbA(1c) and CGM parameters collected over the 3-month treatment period were compared using MANOVA for repeated measures. Results: After 3 months, HbA(1c) significantly decreased from 8.4 +/- 1.0% (65 +/- 1 mmol/mol) to 7.6 +/- 1.0% (60 +/- 11 mmol/mol; p < 0.01). Similarly, mean CGM glucose values significantly decreased from 9.9 +/- 1.9 to 8.9 +/- 2.1 mmol/L (p = 0.05). The frequency of glucose values > 10 mmol/L significantly decreased from 41.3 +/- 21.9% to 30.1 +/- 22.4% (p < 0.05), without a significant increase in the frequency of glucose values < 3.3 mmol/L. Insulin requirements significantly increased from 70 +/- 51 IU/d to 82 +/- 77 IU/d (p < 0.001), without significant changes in body weight. Conclusions: CGM-adapted insulin regimen improves glycemic control without increasing hypoglycemic events in hemodialyzed diabetic patients. CGM could be a useful tool for the management of insulin therapy in these patients. These results need to be confirmed by long-term studies with larger sample sizes.