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. 2022 Sep-Oct;26(5):439-445.
doi: 10.4103/ijem.ijem_157_22. Epub 2022 Nov 22.

Targeting Predialysis Glucose up to 180 mg/dl Reduces Glycemic Variability in End Stage Diabetic Nephropathy

Nikita Shah  1 , Jugal V Gada  1 , Vishwanath S Billa  2 , Jatin Piyush Kothari  3 , Shrirang D Bichu  4 , Deepa H Usulumarty  2 , Suhas S Khaire  1 , Premlata K Varthakavi  1 , Nikhil M Bhagwat  1
Affiliations

Targeting Predialysis Glucose up to 180 mg/dl Reduces Glycemic Variability in End Stage Diabetic Nephropathy

Nikita Shah et al. Indian J Endocrinol Metab. 2022 Sep-Oct.

Abstract

Context: Glycemic variability plays a major role in the development as well as the progression of cardiovascular disease in diabetes.

Aims: We compared the mean plasma glucose and glycemic variability (GV) parameters on and off hemodialysis (HD) in patients with End-Stage Diabetic Nephropathy (ESDN) and End-Stage Renal Disease (ESRD).

Settings and design: Cross-sectional study.

Methods and material: We included 23 ESDN and 6 ESRD patients who underwent continuous glucose monitoring (CGM) (iPro2) for 6 days and a glucose-free dialysate for 4 hours thrice weekly. EasyGV software was used to calculate the variability parameters {mean glucose, Time in range (TIR), Time above and below range (TAR/TBR), CV (Coefficient of Variation) and MAGE}.

Statistical analysis used: The quantitative data variables were expressed by using mean and SD. Unpaired t-test was used to compare the two groups. P value <0.05 was considered significant.

Results: In the ESDN group, TIR was significantly lower whereas TAR and TBR were significantly higher on HD day. MAGE (101.88 ± 40.5 v/s 89.46 ± 30.0, P < 0.007) and CV (29.41% v/s 21.67%) were higher on HD day. Subjects with pre-HD glucose values ≥180 mg/dl (Group B, n = 24) had a rapid drop with a delayed higher rise in glucose values than those with pre-HD glucose values <180 mg/dl (Group A, n = 27). Ten patients had 13 episodes of hypoglycemia. The CGM parameters were not different in the ESRD group.

Conclusions: Targeting a pre- HD glucose value <180 mg/dl could be a good strategy to prevent larger fluctuation during and post HD.

Keywords: Continuous glucose monitoring system; end stage diabetic nephropathy; glycemic variability; hemodialysis; mean amplitude of glycemic excursion (MAGE); type 2 diabetes mellitus.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Methodology and chronology of blood glucose monitoring using a CGMS in this study
Figure 2
Figure 2
(a) Mean glucose of each patient on HD and off HD day (Group mean, 180.54 ± 53.1 vs. 181.08 ± 39.24*P = 0.9). (b) Mage of each patient on HD and off HD day (Group MAGE, 101.88 ± 40.5 and 89.46 ± 30.0, respectively, with P < 0.007*)
Figure 3
Figure 3
(a) The12 hour glucose pattern (4 hours pre, 4 hours post and during HD) in ESDN and ESRD group. (b) Comparison of Glycemic Pattern on HD between Group A and Group B
Figure 4
Figure 4
Duration (width) and severity (height) of hypoglycemia episodes of 10 patients
See this image and copyright information in PMC

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