HOW DOES THE USE OF CONTINUOUS GLUCOSE MONITORING DIFFER AMONG PEOPLE WITH ESKD AFTER KIDNEY TRANSPLANTATION, ON HEMODIALYSIS, AND ON PERITONEAL DIALYSIS?

Continuous glycemic monitoring (CGM) systems are currently an important element of diabetes management among various groups of patients. There is still a lack of data on the confirmed benefits of CGMS among patients with ESRD. We conducted a two-center study to compare 2 CGM systems and evaluate the glycemic profiles of people with end-stage renal disease (ESRD) treated with different renal replacement therapies (RRT).

Study participants used a Dexcom G6 CGM and Medtronic’s Guardian Connect CGM for 30 days each. Additionally, we assessed the impact of monthly use of the above systems on glycated hemoglobin levels and quality of life using the WHOQOL-BREF questionnaire.

Over a period of 20 months, 1 person on peritoneal dialysis, 4 people on hemodialysis, and 9 people after kidney transplantation were included in the study. As many as 22 people on hemodialysis and 9 people on peritoneal dialysis refused to participate in the study due to the feeling of overmedicalization of everyday life, a sense of surveillance, and reluctance to constantly wear the device on the skin. However, no person after kidney transplantation refused to participate in the study due to the above reasons.

In people with NODAT, the time within the target range was above 70%. In all study participants after kidney transplantation, hyperglycemia was observed mainly in the afternoon (2-6 p.m.). In some patients, pressure-induced sensor attenuations (PISAs) were noted.

Data regarding times in hemodialysis patients indicated very poor glycemic control. None of the records met even the most liberal criteria for good glycemic control. More than half a thousand readings were non-numeric data, only informing that the glycemia was above 400 mg/dl or below 40 mg/dl.

The use of a CGM system and a smartphone’s voice assistant was especially helpful for people with advanced diabetic retinopathy. None of the study participants experienced severe hypoglycemia while participating in the study.

There was no impact of the use of CGM systems on the HbA1c level. There was no impact of the use of the CGM system on the perception of quality of life, but monthly use had a positive impact on the perception of the quality of health.

This study shows the problem of overmedicalization among dialysis patients. It seems that in this group it is necessary to pay more attention to the principles of quaternary health prevention and to ensure the safety of people with ESRD in Dialysis Centers.

CGM systems seem to be a promising and helpful method for assessing glycemic control especially in people with diabetes after kidney transplantation.