Clinical research on blood glucose fluctuations in peritoneal dialysis patients with end stage diabetic nephropathy attaining glycated hemoglobin standard

Abstract

Objective To investigate the characteristics of blood glucose fluctuation of continuous ambulatory peritoneal dialysis (CAPD) patients with end stage diabetic nephropathy(ESDN) attaining glycated hemoglobin standard. Methods The study recruited 17 patients with type 2 diabetes attaining glycated hemoglobin standard, and used continuous glucose monitoring system (CGMS) to monitor glycemic variation for 72 h. General information was collected and biochemical indexes were determined. Results The mean amplitude glycemic excur-sions (MAGE), standard deviation, mean blood glucose levels, maximum of blood sugar, and the proportion of greater than 13.9 mmol/L in peritoneal dialysis patients were (8.36±4.44) mmol/L, (3.38±1.08) mmol/L, (9.88±1.92) mmol/L, (17.95±13.11)%, which were significantly higher than those in normal. The mean amplitude glycemic excur-sions (MAGE), standard deviation, mean blood glucose levels, maximum of blood sugar, and the proportion of greater than 13.9 mmol/L in daytime were (8.25±3.71) mmol/L, (2.83±0.89) mmol/L, (11.32±2.54) mmol/L, (16.61±3.86) mmol/L, (28.45±19.56)%, which were significantly higher than those in nighttime: (4.20±2.67) mmol/L, (1.34±0.89) mmol/L, (7.02±1.92) mmol/L, (9.61±2.77) mmol/L, (5.31±1.28)%, all P 0.05). Besides, biochemical glycosylated hemoglobin was less than the calculated from CGMS: (5.88±0.73)% vs. (7.85±1.20)%, t=4.76, P<0.01. Conclusions Peritoneal dialysis patients with ESDN have an increased glycemic fluctuation and a unsatisfied glycemic control, which is worse in daytime. Glycosylated hemoglobin is undervalued. Glycosylated hemoglobin should not be simply used on hemodialysis patients with ESDN to evaluate whether they have a good glycemic control. CGMS can better describe their blood sugar condition. Key words: Diabetic nephropathy; Peritoneal dialysis; Blood glucose; Continuous glucose monitoring system