Glucose tolerance in patients with and without type 2 diabetes mellitus during hemodialysis

Aims: The disposal of a glucose bolus was studied to identify glucose metabolism in patients with and without type 2 diabetes mellitus (T2DM) during their regular hemodialysis (HD) treatment. Methods: Plasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5 g/kg dry weight). Glucose disposition and elimination rates were determined from kinetic analysis, and insulinogenic index was calculated. Insulin resistance (R-HOMA) was determined by homeostatic model assessment (HOMA). Results: 35 HD patients (14 with T2DM) distinguished by a higher age (median: 70 vs. 55 y, p < 0.01) in T2DM patients were studied. Glucose kinetic data showed only small differences between patients with or without T2DM, but as RHOMA measured in all patients increased, a larger fraction of glucose was removed by the extracorporeal system (r = 0.430, p = 0.01). One hour after glucose bolus injection the glucose level was not different from that before HD also in patients with T2DM (p = 0.115). Conclusions: The larger glucose amount recovered in dialysate in patients with increasing RHOMA indicates that impaired glucose disposal could be measured during HD using a non-invasive dialysis quantification approach without blood sampling. Glucose infusion during HD is safe also in patients with T2DM. (C) 2021 The Author(s). Published by Elsevier B.V.

Automated summary

The study aimed to investigate glucose metabolism in HD patients with and without T2DM. Results showed that as R-HOMA increased, a larger fraction of glucose was removed by the extracorporeal system. Overall, glucose infusion during HD was found to be safe, even for patients with T2DM.