Efficacy of continuous glucose monitoring in people living with diabetes and end stage kidney disease on dialysis: a systematic review

• Published in: BMC nephrology Vol. 25; no. 1; pp. 379 - 8
• Main Authors: Zhang, Yimeng, Singh, Pushpa, Ganapathy, Kavitha, Suresh, Vijayan, Karamat, Muhammad Ali, Baharani, Jyoti, Bellary, Srikanth
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.10.2024; BioMed Central; BMC
• Subjects: Acidosis; Analysis; Blood Glucose - analysis; Blood Glucose - metabolism; Blood Glucose Self-Monitoring - methods; Blood sugar monitoring; Care and treatment; Chronic kidney failure; Clinical trials; Continuous Glucose Monitoring; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus - blood; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - therapy; Diabetic kidney disease; Diabetic Nephropathies - blood; Diabetic Nephropathies - therapy; Diabetics; Dialysis; Glucose metabolism; Glucose monitoring; Glycated Hemoglobin - analysis; Glycemic index; Haemodialysis; Health aspects; Hemodialysis; Humans; Hypoglycemia; Hypoglycemia - blood; Hypoglycemia - etiology; Insulin resistance; Kidney diseases; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Metabolism; Patient outcomes; Peritoneal dialysis; Prevention; Quality of life; Renal Dialysis; Risk factors; Systematic review; Treatment Outcome; United Kingdom; Systematic review; Dialysis; Haemodialysis; Diabetes mellitus; Peritoneal dialysis; Diabetic kidney disease
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-024-03763-z

Patients with diabetes on dialysis experience wide variations in glucose levels and an increased risk of hypoglycaemia. Due to the inaccuracies of HbA1c in dialysis patients, JBDS-IP and KDIGO recommend the use of continuous glucose monitoring (CGM). We conducted a systematic review to examine the current evidence for CGM use and its impact on clinical outcomes in patients with diabetes on dialysis. A search of MEDLINE(R) ALL, Ovid Emcare, Journals@Ovid Full Text and Embase databases were conducted. Clinical or observational trials in adults with Type 1(T1D) or Type 2 (T2D) diabetes on dialysis and CGM intervention reporting on glycaemic outcomes were included. Of the 936 citations identified, 49 duplicates were removed. 887 citations were screened by title and abstract. 9 full texts were reviewed and a further 7 excluded due to duplications or failure to meet to selection criteria. Data was extracted for 2 studies, both prospective before-and-after interventional studies with no control group. Joubert et al. (2015) showed results for 15 participants with T1D. Mean CGM glucose level decreased from 8.37mmol/L at baseline to 7.7mmol/L at the end of the CGM period (p < 0.05) while HbA1c decreased from 6.9 to 6.5% (p < 0.05) during the same period. Mean CGM was lower on dialysis days (7.68mmol/L vs. 7.8mmol/L, p < 0.05). Képénékian et al. (2014) reported on data from 29 T2D patients. Following a 3 month CGM-adapted insulin regimen, HbA1c decreased from 8.4% at baseline to 7.6% (p < 0.01) by the end of study. Mean CGM values decreased from 9.9mmol/L to 8.9mmol/L (p = 0.05) and the frequency of glucose values > 10mmol/L decreased from 41 to 30% (p < 0.05), without a significant increase in hypoglycaemia frequency. Both studies were deemed to be of 'good' quality. Evidence demonstrating the benefits of CGM in patients with diabetes receiving dialysis is lacking. There is a need for well-designed randomised controlled trials to ascertain the benefits of this technology in this patient group. PROSPERO registration number: CRD42023371635, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=371635 .