POS-353 DIABETES CARE IN HEMODIALYSIS PATIENTS: ADVANCES MADE IN 2020

Abstract

Management of diabetes and follow-up of haemodialysis patients are still poorly standardized. The objective of this study is to establish a descriptive inventory of all routine parameters for monitoring diabetes and glycemic control by Continuous Glucose Monitoring (CGM). The study recruited 60 diabetic patients in a medical dialysis unit. Glycemic control was assessed using the MCG (FreeStyle Free Pro®) over at least 11 days with measurement of: mean blood glucose level, percentage of blood glucose level: < 0.70g/dl TBR, between 0.70 and 1.80g/dl TIR, and > 1.80 g/dl TAR. The results are expressed in average or median [25-75 percentiles]. SPSS® statistical analyses compared extra and per dialytic periods. Patients’ mean age was 70±11 years, history of diabetes was 22±9 years (93.5% T2DM), mean weight was 78±16kg, HbA1c is 6.9±1.2%, 98% had a high risk of foot injury. Only 43% of the patients were followed by a diabetes specialist and 50% performed self-monitoring of blood glucose levels. 73% were insulin-treated and 19.5% received oral medication. The average blood glucose level was 145.8±12.8 mg/l (~1000 measurements). CGM results for the first 21 patients over the total period were: TIR at 66% [52-73], TAR at 23.2% [13-38], and TBR at 5.4% [0.3-17]. Per-dialytic TIR (80.2%; [75-89]) was significantly higher (p=0.02) than extra-dialytic TIR (65.2%; [52-72]). Per-dialytic TAR (4%; [0-14]) was significantly lower (p<.001) than extra-dialytic TAR (23.8%; [10-37]). TBR did not vary significantly (p=.781). The majority of patients were insulin-treated but only 50% performed self-monitoring of blood glucose levels. Hypoglycaemia was low in dialysis. 98% of patients had a high risk of foot injury. CGM could be a valuable tool in the evaluation of the glycemic profile of haemodialysis patients, the detection of asymptomatic hypoglycemia and thus allow for better adjustment of their treatment.