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In France, 4.5 million people are affected by diabetes, nearly one in ten adults could be affected by 2045. In French Guiana, with a prevalence of about 8%, the population is twice as affected as in mainland France. When associated with local difficulties of access to care, morbidity-mortality is strongly high. As elsewhere, diabetes is one of the major causes of end-stage renal failure (ESRD). However, the prevalence of ESRD is higher in French Guiana than in other regions of France. It is one of the main causes of chronic dialysis, but its prevalence in this population is poorly documented. Hence the interest of this study.
This is a cross-sectional, descriptive, and analytical study, including all patients in chronic hemodialysis (CHD) for at least 6 months at the western Guiana hospital center in 2022, having benefited from an annual assessment in December 2022. The primary outcome was the
occurrence of diabetes mellitus defined according to international criteria at the time of dialysis or developed during dialysis follow-up. We determined the frequency of diabetes, looked for its determinants as well as factors, specific to this extra-renal cleansing technique, which can exert a reciprocal influence with the control of diabetes in this population.
A total of 65 CHD patients were included in the study. The incidence of diabetes was 45% with a female predominance at 55%. Type 2 was predominant and represented 90% but all were insulin-requesters. Patients were older with an average age of 62 years and 94% were hypertensive. The main determinants of diabetes were heredity, advanced age, and obesity (BMI>30, 62%). Blood glucose was not perfectly controlled with an average of HbA1C at 7.5% and fasting blood glucose at 1.5 g/l. Dialytic factors associated with diabetic control were: less effective dialysis (translated by a lower KT/V at 1.16, a higher postdialytic urea level (4.95 mmol/l), hyperkalemia, metabolic acidosis and higher NT-pro BNP levels at the expense of a higher hyposodium overload); undernutrition (defined by a morphological criterion: weight loss ≥ 10% and at least one biological criterion: hypoalbuminemia < 30 g/l and/or hypotransthyretiemia < 110 mg/l), chronic inflammation with a mean CRP of 16.5 mg/l. In addition, diabetes was associated with 62% of erectile dysfunctions reported in men, 60% of physical disabilities, a low rate of registration on the waiting list for renal transplantation and 83% of mortality from all causes.
Diabetes mellitus is common in chronic hemodialysis where it most often requires insulin therapy. Its determinants are the same as in the general population. However, its management must consider the factors intrinsically linked to this extra-renal purification technique with which it interacts with each other. It is associated with a higher morbi-mortality in this population.