Assessment of Glycemic Control by Continuous Glucose Monitoring, Hemoglobin A1c, Fructosamine and Glycated Albumin in Patients with End-Stage Kidney Disease and Burnt-Out Diabetes

Abstract

<p dir="ltr">Background. Patients with diabetes and end-stage kidney disease (ESKD) may experience “burnt-out diabetes”, defined as having a HbA1c <6.5% without antidiabetic therapy for >6 months. </p><p dir="ltr">Methods. This pilot prospective study assessed glycemic control by continuous glucose monitoring (Dexcom CGM), HbA1c, glycated albumin and fructosamine in patients with burnt-out diabetes (n=20) and without a history of diabetes (n=20).</p><p dir="ltr">Results. Patients with burnt-out diabetes had higher CGM-measured daily glucose, lower % time in range 70-180 mg/dL, higher % time above range >250 mg/dL, and longer duration of hyperglycemia >180 mg/dL (hours/day) compared to patients without diabetes (all p<0.01). HbA1c and fructosamine levels were similar; however, patients with burnt-out diabetes had higher levels of glycated albumin than patients without diabetes. </p><p dir="ltr">Conclusion. The use of CGM demonstrated that patients with burnt-out diabetes have significant undiagnosed hyperglycemia. CGM and glycated albumin provide better assessment of glycemic control than HbA1c and fructosamine in patients with ESKD. </p><p dir="ltr"><br></p>