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Use of continuous glucose monitoring in patients with diabetes on peritoneal dialysis: poor correlation with HbA 1c and high incidence of hypoglycaemia
Author(s) -
Oei E.,
Samad N.,
Visser A.,
Chowdhury T. A.,
Fan S. L.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12988
Subject(s) - medicine , peritoneal dialysis , diabetes mellitus , continuous glucose monitoring , gliclazide , dialysis , endocrinology , incidence (geometry) , gastroenterology , type 1 diabetes , physics , optics
Background Achieving adequate glycaemic control in patients with diabetes on peritoneal dialysis is challenging. Traditional assessment of glycaemia using HbA 1c is difficult in such patients because of renal anaemia or carbamylation of haemoglobin, and significant glucose excursions may be masked. We describe three patients with diabetes on peritoneal dialysis with similar HbA 1c levels, but with very different glucose profiles shown on continuous glucose monitoring. Case reports Patient 1 was treated with gliclazide, and had a number of solutions with high glucose concentration in his dialysis prescription. Continuous glucose monitoring showed glucose levels > 11 mmol/l for > 17 h per day, and < 4 mmol/l for 72 min per day with no symptoms. His HbA 1c level was 61 mmol/mol (7.7%). Patient 2 was treated with insulin. Continuous glucose monitoring showed glucose levels > 11 mmol/mol for 3.8 h per day, and < 4 mmol/mol for 3.8 h per day. His HbA 1c level was 59 mmol/mol (7.6%). Patient 3 was treated with pioglitazone and gliclazide, and glucose levels were > 11 mmol/l for 8 h per day and < 4 mmol/l for 1.6 h per day. His HbA 1c was 62 mmol/mol (7.8%). None of the patients was aware of hypoglycaemia during the periods of low glucose recorded on continuous glucose monitoring. Conclusion Despite similar HbA 1c levels, our three patients had very different glucose profiles. These cases highlight the fact that HbA 1c is frequently inadequate in reflecting glucose control in patients with diabetes on peritoneal dialysis, and we suggest that intermittent continuous glucose monitoring may allow safer management of glycaemia in such patients.