Abstract
Patients with moderate-to-advanced diabetic kidney disease (DKD) are at high risk of hypoglycemia. There are few studies evaluating personal continuous glucose monitoring (CGM) use in this group. We investigated whether flash glucose monitoring (FGM) was effective in reducing hypoglycemia compared with standard self-monitoring of blood glucose (SMBG) in individuals with chronic kidney disease (CKD) stages 3b-5 (non-dialysis). This was a single-centre, parallel-group randomised clinical trial of 94 adults with diabetes and CKD [G3b (n=36), G4 (n=44) and G5 (n=14)] and a history of hypoglycemia. Patients were randomly assigned 1:1 to FGM or SMBG for 16 weeks. Both groups received structured education on hypoglycemia and monthly reviews by healthcare professionals. Blinded CGM was performed at baseline and end of study in both groups. Patients were aged (mean±SD) 65.4±9.0 years with estimated glomerular filtration rate (eGFR) 26.1±9.6 ml/min/1.73m2, HbA1c 7.4±0.8% and median duration of diabetes for 20 years. 93 patients had type 2 diabetes and 99% were on insulin. After 16 weeks, percentage time <70mg/dL (3.9 mmol/L) decreased significantly from 4.0% to 2.5% in FGM group (- 1.7%; 95% CI -3.4 to -0.01%) but not in SMBG group (-1.1%; 95% CI -2.6 to 0.4%; between-group difference, p=0.73). Mean HbA1c improved significantly in both FGM (-0.33%, 95% CI -0.52 to -0.1) and SMBG groups (-0.36%, 95% CI -0.52 to -0.21; between-group difference p=0.08). One severe hypoglycemic event occurred in the FGM and none in SMBG group. The acceptability of FGM was high with overall 87% mean sensor use and average 8 scans per day. FGM was effective in reducing hypoglycemia and improving HbA1c in moderate-to-advanced DKD, but not significantly different from SMBG. Future studies are needed to assess whether real-time CGM with alerts would further reduce hypoglycemic episodes in this high-risk group. Disclosure J. Ling: None. J. K. Ng: None. R. C. Ma: Other Relationship; Self; AstraZeneca, Medtronic, Research Support; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Tricida, Inc. A. P. Kong: Advisory Panel; Self; Lilly Diabetes, Speaker’s Bureau; Self; Abbott, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Lilly Diabetes, Sanofi, Stock/Shareholder; Self; Aptorum. A. Luk: None. C. Szeto: None. J. C. Chan: Consultant; Self; Bayer AG, Boehringer Ingelheim International GmbH, MSD Corporation, Sanofi, Other Relationship; Self; Asia Diabetes Foundation, GemVCare, Research Support; Self; Applied Therapeutics, AstraZeneca, Hua Medicine, Lilly Diabetes, Merck KGaA. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. Funding Hong Kong College of Physicians; University Grants Committee Research Matching Grant Scheme
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