Assessing Glycemic Variability and Insulin Dose Adjustment in Chronic Hemodialysis Patients with Type 2 Diabetes : Use of a 72-Hr Continuous Glucose Monitoring System
Presentation Number: SUN 614
Date of Presentation: April 2nd, 2017
Worapaka Manosroi*1, Chanachai Chantarakhit2 and Ampica Mangklabruks2
1Endocrinology and Metabolism unit, Chiangmai, Thailand, 2Endocrinology and Metabolism Unit, Chiang Mai, Thailand
Diabetic nephropathy is the leading cause of the end-stage renal failure. In diabetes
patients with end stage renal disease who on long term hemodialysis, glycemic dysregulation
can occur from various factors. The application of the continuous glucose monitoring system
(CGMS) may improve the management of insulin therapy and can determine glycemic variab
ility patterns during the peri-dialysis session in the diabetes mellitus type 2 patients undergoing
the long term hemodialysis.
To determine the patterns of glycemic variability among chronic hemodialysis patients
with T2DM during pre-, intra- and post-hemodialysis period.
Materials and methods
The prospective study was done during 1 April 2013 – 31 January 2014 at the Internal
Medicine Unit at Maharaj Nakorn Chiang Mai Hospital,Thailand. The 46 diabetes with long
term hemodialysis patients who met the inclusion criteria were informed and enrolled. The
72-hr CGMS (iPro2) were installed on the anterior abdominal wall of the patients and they
were trained to use and the calibrate CGMS. After 72 hours, the data were
downloaded to the computer. The data from the CGMS including baseline characterictics
and laboratory data were collected and statistically analysed by SPSS version 16.0. Mean
average glucose excursion (MAGE) was calculated to indicate glycemic variabilities.
The 30(65.2%) patients were male and 16(34.8%) were female with the mean age of
62.3 ±5.8 years old. There were 30(65.2%) patients who used pre-mixed insulin. 6 of 46(13%)
patients had hold their insulin during hemodialysis day. Three patterns of blood glucose
during pre-, intra- and post-hemodialysis period were established which were stable of blood
glucose, decreased in blood glucose(<70mg/dL) after hemodialysis and increased in blood
glucose (>180mg/dL) after hemodialysis. The patients who used higher dose of insulin and
who hold the insulin on hemodialysis day were the strongest factors to indicate that they would
have stable blood glucose during hemodialysis day (p=0.04 and 0.03, respectively). The MAGE was highest on the day after
hemodialysis (102.1 mg/dL) and there was a significant difference in MAGE between the
pre- and post- hemodialysis day (79.2 and 102.1 mg/dL, p=0.006). Neither type nor dose
of insulin was the significant factor to designate MAGE value or hypoglycemic event.
Using CGMS in long term hemodialysis diabetes patients may provide benefits in
terms of guiding the patients to adjust the insulin dose and lifestyle changing during peri- dialysis day
based on the blood glucose pattern.
Nothing to Disclose: WM, CC, AM