957-P: Continuous Glucose Monitoring in Patients with End-Stage Kidney Disease and Burnt-Out Diabetes

Abstract

Patients with long-standing type 2 diabetes and end-stage kidney disease (ESKD) on dialysis may experience resolution of their hyperglycemia, as defined by an HbA1c < 6.5%, without antidiabetic therapy. This phenomenon is known as “burnt-out diabetes”. Because HbA1c may be falsely low in patients with ESKD/dialysis therapy, we conducted a prospective study to compare glycemic control as measured by Dexcom G6 CGM in patients with ESKD and burnt-out diabetes and those without history of diabetes. We hypothesize that the use of CGM may provide better assessment of glycemic control than HbA1c (standard-of-care) in these patients and clarify the glycemic characteristics of burnt-out diabetes. We included adults with ESKD on dialysis, with (n=20) and without (n=10) a known history of diabetes, and with HbA1c <6.5% without antidiabetic therapy for > 6 months. All subjects wore a blinded Dexcom G6 CGM for 10 days. Their clinical characteristics and CGM metrics are shown in Table 1. Conclusion: CGM provides better assessment of glycemic excursions, compared to HbA1c, in patients with ESKD and diabetes. Most patients with burnt-out diabetes (HbA1c <6.5%, off therapy) have frequent and significant hyperglycemic excursions as detected by CGM. Further research will need to examine whether these excursions require pharmacotherapy. Disclosure C.Kaminski: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. Z.E.Zabala: None. B.Moazzami: None. A.Y.G.Gerges: None. R.G.Mccoy: Consultant; Emmi. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob's Fund for Education