Novel clinical associations between time in range and microangiopathies in people with type 2 diabetes mellitus on hemodialysis

• Published in: Journal of diabetes and its complications Vol. 37; no. 5; p. 108470
• Main Authors: Hayashi, Akinori, Shimizu, Naoya, Suzuki, Agena, Fujishima, Rei, Matoba, Kenta, Moriguchi, Ibuki, Kobayashi, Naoyuki, Miyatsuka, Takeshi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023; Elsevier Limited
• Subjects: Blood diseases; Blood Glucose; Blood Glucose Self-Monitoring; Continuous glucose monitoring; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetic neuropathy; Diabetic retinopathy; Diabetic Retinopathy - epidemiology; Glucose monitoring; Glycated albumin; Glycated Hemoglobin; Glycated Serum Albumin; Glycation End Products, Advanced; HbA1c; Hemodialysis; Hemoglobin; Humans; Hypoglycemia; Kidney diseases; Mortality; Patients; Renal Dialysis - adverse effects; Serum Albumin; Time in range; Vascular Diseases; United States > US; Japan; Continuous glucose monitoring; Glycated albumin; Hemodialysis; HbA1c; Time in range; HbA(1c)
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2023.108470

We investigated associations among glucose time in range (TIR, 70–180 mg/dL), glycemic markers and prevalence of diabetic microangiopathy in people with diabetes undergoing hemodialysis (HD). A total of 107 people with type 2 diabetes undergoing HD (HbA1c 6.4 %; glycated albumin [GA] 20.6 %) using continuous glucose monitoring were analyzed in this observational and cross-sectional study. HbA1c and GA levels significantly negatively correlated with TIR, and positively correlated with time rate of hyperglycemia, but not with time rate of hypoglycemia. TIR of 70 % corresponded to HbA1c of 6.5 % and GA of 21.2 %. The estimated HbA1c level corresponding to TIR of 70 % in this study was lower than that previously reported in people with diabetes without HD. The prevalence of diabetic neuropathy was not significantly different between people with TIR ≥ 70 % and those with TIR < 70 % (P = 0.1925), but the prevalence of diabetic retinopathy in people with TIR ≥ 70 % was significantly lower than in those with TIR < 70 % (P = 0.0071). TIR correlated with HbA1c and GA levels in people with type 2 diabetes on HD. Additionally, a higher TIR resulted in a lower rate of diabetic retinopathy. What is already known about this subject?–HbA1c and glycated albumin (GA) are associated with mortality and comorbidity in people with diabetes undergoing hemodialysis (HD).–Continuous glucose monitoring (CGM) revealed high glycemic variability and hypoglycemia related with HD. What is the key question?–There is insufficient evidence to determine whether glucose time in range (TIR; 70–180 mg/dL) by CGM correlates with HbA1c and GA or with other microvascular complications in HD people with diabetes. What are the new findings?–HbA1c and GA levels significantly negatively correlated with TIR, and positively correlated with time rate of hyperglycemia, but not with time rate of hypoglycemia.–Comparing people with TIR ≥ 70 % and TIR < 70 %, there was no difference in the prevalence of neuropathy, but the prevalence of retinopathy was significantly less in people with TIR ≥ 70 %. How might this impact on clinical practice in the foreseeable future?–TIR is also useful as a new glycemic management parameter in people with type 2 diabetes on HD. •We evaluated the associations between TIR and glycemic markers, and microangiopathies in type 2 diabetes on hemodialysis.•HbA1c and glycated albumin significantly correlated with TIR and time of hyperglycemia, but not with time of hypoglycemia.•TIR ≥ 70% associated with significantly lower retinopathy prevalence but no difference in neuropathy compared to TIR < 70%.