Effectiveness of continuous glucose monitoring in dialysis patients with diabetes: The DIALYDIAB pilot study

Aims: The DIALYDIAB trial addresses the contribution of iterative sequences of continuous glucose monitoring (CGM) on glucose control in dialysis patients with diabetes. Materials and methods: In this before-after monocentric 12-week pilot study, dialysis patients with diabetes were monitored with self-monitoring blood glucose (SMBG) 3 times per day during a 6-week period followed by a 5-day CGM recording at 2-week interval during another 6-week period. SMBG and CGM profiles were remotely analyzed by a single diabetes expert who gave therapeutic counseling to dialysis physicians. Results: Fifteen patients who entered the study had a male/female ratio 8/7, age 60.9 +/- 14.8 years, BMI 29.9 +/- 7.8, diabetes duration 19.2 +/- 8.5 years and dialysis duration 6.5 +/- 6.9 years. Treatments were diet alone (20%) or diet plus insulin (80%). Mean CGM glucose level was 8.3 +/- 2.5 mmol/l at baseline (T0), 8.2 +/- 1.6 mmol/l at the end of the SMBG period (T1) (ns) and 7.7 +/- 1.6 mmol/l at the end of the CGM period (T2) (p < 0.05 vs T0). Glucose AUC > 10 mmol/l was 0.9 +/- 1.4 mmol/l/day at T0 and decreased to 0.4 +/- 0.5 at T2 (p < 0.05)) without change in glucose AUC < 3.3 mmol/l. Treatment adaptation was higher during the CGM period (1.4 +/- 1.0 and 2.1 +/- 0.9 treatment change at T1 and T2, respectively; p < 0.05). Conclusions: In patients with diabetes on chronic dialysis, iterative CGM monitoring was associated with more frequent treatment changes and finally, better glucose control, without increased risk of hypoglycemia. (C) 2015 Elsevier Ireland Ltd. All rights reserved.