1329-P: Prevalence of Diabetic Burn-Out in Patients on Dialysis—A Rapid Evidence Review and Meta-analysis

Abstract

In diabetic patients on dialysis, glycemic control may improve spontaneously, leading to normal glycated hemoglobin (HbA1c) levels and termination of antidiabetic medications; this phenomenon is known as “burnt-out diabetes.” It has been previously shown that diabetic patients on dialysis with normal and less than normal glycated hemoglobin levels may have a higher risk of mortality. The aim of this systematic review and meta-analysis is to determine the prevalence of diabetic burn-out in patients with diabetic nephropathy on dialysis. Web of Science, Scopus, and PubMed were searched from inception to January 2023. Only studies that obtained samples from populations which reported the number of patients with diabetic burn-out, defined as: HgbA1c < 6.0%, cessation of antidiabetic medication, and on dialysis were included. The primary meta-analysis outcome was prevalence of diabetic burn-out. A random effects meta-analysis was carried out using RStudio software. Four studies, conducted between 2007 and 2018, met the inclusion criteria and contributed 139,690 diabetic patients (sample size range, 1296-60,019). The pooled estimation of prevalence of diabetic burn out in patients on dialysis was 28.8% (95% CI, 28.6%-29.0%). Prevalence in the included studies varied from 18.6% to 39.7%. We found a high heterogeneity (I2= 100%, p < 0.000, Q = 6641.79) in prevalence reported among studies. In conclusion, we found that the “burnt-out diabetes” phenomenon may exist in 28.8% of HD patients with diabetes in terms of HbA1c levels. Additional studies are needed to determine the optimal target for hemoglobin A1c levels in hemodialysis patients with diabetes. Disclosure T.L.Coye: None. P.Crisologo: None. L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew.