Continuous glucose monitoring improves detection of glycemic excursions in hemodialysis patients with type 2 diabetes

Abstract Background Optimal glucose management in individuals with type 2 diabetes (T2D) and end-stage kidney disease (ESKD) on hemodialysis is challenging. We compared the detection of glycemic excursions with continuous glucose monitoring (CGM) and capillary glucose testing (CBG) in this population. Methods In this prospective observational study, insulin-treated adults with T2D on hemodialysis for ≥90 days wore a Dexcom G6-Pro CGM. Participants were instructed to perform CBG up to 4 times daily. We compared differences in glucose metrics and described CGM patterns in relation to dialysis sessions. Results Among 59 participants (age 57. 7±9years, HbA1c 7.09%), mean glucose measured by CBG and CGM was 165.7 ± 41.8 and 188.9 ± 45.0, with a time-in-range (TIR) of 68%±23 and 51%±26, respectively (p < 0.001). CGM detected that all participants had hyperglycemic episodes of 180mg/dL, with time-above-range (TAR) 180mg/dL of 47.8%±27, and 90% had episodes of >250mg/dL, with TAR >250mg/dL of 20.9%±21.7. CGM detected higher rates of hypoglycemia <70mg/dL, (47% vs. 25%, p=0.005) and <54mg/dL, (25% vs. 12%, p=0.08) than CBG testing. Nocturnal and prolonged hypoglycemia <70mg/dL were only detected by CGM (29% and 12%, respectively). CGM showed a pattern of improved glucose levels on pre-dialysis days, lower glucose levels during hemodialysis, and a rapid rise during the post-dialysis period. Conclusions In participants with T2D and ESKD on hemodialysis, CGM improved the detection of hyperglycemic and hypoglycemic events, particularly nocturnal and prolonged episodes. CGM revealed distinct glycemic patterns related to dialysis sessions, potentially enabling more personalized management.