Accuracy of Continuous Glucose Monitoring for Diabetes Patients on Hemodialysis

Continuous glucose monitoring (CGM) is a convenient method for individuals with diabetes to measure their blood glucose levels. Its use generally leads to reduced hypoglycemia and hyperglycemia, and more time within the target glucose range.

However, the accuracy of CGM compared to traditional self-monitored blood glucose among patients receiving hemodialysis is not well known. Yoko Narasaki and colleagues conducted research to fill this gap and published the results in Diabetes Care.

Participants comprised 31 patients with diabetes receiving maintenance hemodialysis and hospitalized from October 2020 to May 2021. Protocolized glucose measurements were taken using Dexcom G6 CGM and blood glucose. Blood glucose was measured before each meal, at night, and every 30 minutes during hemodialysis.

The researchers studied agreement and correlations between CGM and blood glucose readings utilizing Bland-Altman plots, percentage of agreement, mean and median absolute relative differences (ARDs), and consensus error grids.

Agreement rates between CGM and blood glucose using %20/20 criteria were 48.7%, 47.2%, and 50.2% during the overall, hemodialysis, and nonhemodialysis periods, respectively. Pearson and Spearman correlations for averaged CGM compared to blood glucose levels were 0.84 and 0.79, respectively. Bland-Altman plots found the mean difference between CGM and blood glucose to be ~+15 mg/dL.

The mean ARD was ∼20% for all time periods. The median ARD was 19.4% during the overall period, 22.0% during hemodialysis, and 18.2% during the nonhemodialysis period. Consensus error grids found that almost all CGM values were in clinically acceptable zones A (no harm) and B (unlikely to cause significant harm).

In summary, mean ARD values were higher than traditional optimal analytic performance thresholds in hemodialysis patients with diabetes, but error grids found that nearly all CGM values were within clinically acceptable zones. Additional studies could shed light on whether the use of CGM improves outcomes in hemodialysis patients.

Source: Diabetes Care