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

Autor: Zhang Y; Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Singh P; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Ganapathy K; Department of Diabetes and Endocrinology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK., Suresh V; Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Karamat MA; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Baharani J; Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Bellary S; School of Life and Health Sciences, Metabolic Medicine, Aston Triangle, Aston University, Birmingham, B4 74T, UK. s.bellary@aston.ac.uk.; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. s.bellary@aston.ac.uk.
Jazyk: angličtina
Zdroj: BMC nephrology [BMC Nephrol] 2024 Oct 25; Vol. 25 (1), pp. 379. Date of Electronic Publication: 2024 Oct 25.
DOI: 10.1186/s12882-024-03763-z
Abstrakt: Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Trail Registration: PROSPERO registration number: CRD42023371635, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=371635 .
(© 2024. The Author(s).)
Databáze: MEDLINE
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