Objective:

To evaluate the impact of real-time continuous glucose monitoring (CGM) on glycemic control in patients with insulin-treated type 2 diabetes receiving maintenance hemodialysis.

Approach:

• Study Design: A prospective, randomized crossover trial conducted at Emory Healthcare dialysis centers involving patients aged 18 to 80 with type 2 diabetes and end-stage kidney failure.
• Participants: 52 enrolled patients, with 39 included in the modified intention-to-treat analysis after exclusions.
• Intervention: Participants used the Dexcom G6 CGM for 30 days followed by a washout and crossover to standard capillary blood glucose testing.
• Outcomes: Primary outcome was time below 70 mg/dL; secondary outcomes included time in range (70-180 mg/dL), time above 180 mg/dL, mean glucose, and measures of hypo- and hyperglycemia.

Key Findings:

• Time below 70 mg/dL did not differ significantly between CGM (1.2%) and capillary testing (1.3%).
• Mean time in the target range was higher with CGM (63%) compared to capillary testing (55%).
• Mean glucose was lower during CGM (174 mg/dL) compared to capillary testing (188 mg/dL).
• Hyperglycemic episodes remained common, with 95% of patients experiencing glucose above 250 mg/dL during CGM.

Interpretation:

Real-time CGM improved secondary glycemic measures but did not significantly reduce hypoglycemia rates.

Limitations:

• Small sample size and inclusion of only insulin-treated patients.
• Low time below range limited the potential for improvement in the primary outcome.
• Challenges in conducting research in a medically complex population.

Conclusion:

Real-time continuous glucose monitoring improved time in range and reduced time above range during the intervention.

Sources:

• Diabetes Care