Usefulness of glucose management indicator derived from continuous glucose monitoring to assess glycemic condition in hospitalized patients with diabetic kidney disease treated with insulin pumps

Abstract

Background and objectiveThis study described the relationship of HbA1c and continuous glucose monitoring (CGM) derived glucose management indicator (CGM-derived GMI) and developed a model to estimate GMI based on clinical parameters (clinical-parameter GMI) for hospitalized DKD treated with insulin pump. MethodsThis observational study collected clinical data of hospitalized DKD treated with insulin pump between February 2022 to February 2023. According to estimated glomerular filtration rate (eGFR), 156 participants were divided into G1–2 (n = 64), G3 (n = 56) and G4–5 (n = 36). Correlation between HbA1c and CGM-derived GMI was tested. Study population was divided into training and validation set based on ratio of 6:4. In training set, a linear model was established to calculate clinical-parameter GMI. In validation set, paired t-test and residual analysis was used to examine the difference between CGM-derived GMI and clinical-parameter GMI. ResultsWith renal function reduced, the correlation of HbA1c and CGM-derived GMI decreased. Meanwhile, as renal function reduced, the discordance between HbA1c and CGM-derived GMI decreased as well (P = 0.009). In training set, based on eGFR stages, anemia, albumin, FBG and HbA1c, formula to clinical-parameter GMI was established. In validation set, the differences between clinical-parameter GMI and CGM-derived GMI was around 0, with 95 % confidence interval of −1.8 % to 1.5 %. ConclusionsHbA1c may be less accurate to reflect glycemic condition for DKD with impaired renal function. A easily accessiable model based on clinical parameter to estimate GMI may help assess glycemia for hospitalized DKD treated with insulin pump.