Abstract
BackgroundPlasma glucose variability may confer a risk for development of chronic diabetic complications. Glycosylated hemoglobin (HbA1c) reflects average glucose level but not glucose variability, which is measured by mean amplitude of glycemic excursions (MAGEs) and continuous glucose monitoring (CGM).AimTo study glucose variability using CGM/MAGE compared with sugar profiles and to assess their value as a therapy guide in patients with diabetic nephropathy on hemodialysis.Patients and methodsGroup 1 included 50 patients with type 2 diabetes mellitus (T2DM) without diabetic nephropathy. Group 2 included 50 patients with T2DM with diabetic nephropathy. Group 3 included 50 patients with T2DM with diabetic nephropathy on hemodialysis. Measurements of fasting blood glucose, postprandial blood glucose, HbA1c, and glucose variability by MAGE and CGM were done.ResultsCGM showed significant blood glucose variability (amplitude>130 mg/dl in 40 patients=80% using CGM and in 45 patients=90% using MAGE) in dialysis group (group 3) in comparison with glucose variability in nondialysis groups (group 1+group 2) (amplitude>130 mg/dl in 20 patients=20% using either CGM or MAGE). Group 1 showed significant correlations between either CGM or MAGE and all sugar profiles. Group 2 showed significant correlations between CGM and MAGE with either fasting or postprandial blood glucose but not with HbA1c, whereas group 3 showed nonsignificant correlations between either CGM or MAGE and any of sugar profiles.ConclusionCGM/MAGE have high specificity and sensitivity to measure variability of sugar levels, especially in patients with diabetic nephropathy on hemodialysis or not, in which HbA1c may not be a reliable tool.
Highlights
Several interventional and epidemiological studies have confirmed the association between hyperglycemia and the development of diabetic complications in patients with both type 1 and type 2 diabetes [1]
We found a statistically significant increase of HbA1c in group 3 more than the other two groups. This is in agreement with Jin et al [11] whose stated that diabetic hemodialysis patients are associated with bad diabetes control with HbA1c more than 7%, which is common in uremic states, as the uremic toxin influences glucose homeostasis by decreasing insulin sensitivity, increasing hepatic gluconeogenesis, and decreasing cellular glucose utilization in end-stage renal disease
Our results showed a significant positive correlation between mean amplitude of glycemic excursions (MAGEs) or continuous glucose monitoring (CGM) with urinary albumin/creatinine ratio (UACR) in all our three groups, and this result is in concordance with study of Nalysnyk et al [18] who stated that plasma glucose (PG) variability, irrespective of the hyperglycemic levels, can confer mored risk for the development of macrovascular and microvascular diabetic complications and can be explained by increasing frequency and magnitude of glycemic variability, which generates more reactive oxygen species and results in an increased risk for the development of long-term diabetic complications [5]
Summary
Several interventional and epidemiological studies have confirmed the association between hyperglycemia and the development of diabetic complications in patients with both type 1 and type 2 diabetes [1] Most of these studies have used glycosylated hemoglobin (HbA1c) as time-averaged mean levels of glycemia [2]. Aim To study glucose variability using CGM/MAGE compared with sugar profiles and to assess their value as a therapy guide in patients with diabetic nephropathy on hemodialysis. Group 2 showed significant correlations between CGM and MAGE with either fasting or postprandial blood glucose but not with HbA1c, whereas group 3 showed nonsignificant correlations between either CGM or MAGE and any of sugar profiles. Conclusion CGM/MAGE have high specificity and sensitivity to measure variability of sugar levels, especially in patients with diabetic nephropathy on hemodialysis or not, in which HbA1c may not be a reliable tool
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call