Assessment of Glycemic Control by Continuous Glucose Monitoring, Hemoglobin A1c, Fructosamine, and Glycated Albumin in Patients With End-Stage Kidney Disease and Burnt-Out Diabetes

Author:

Kaminski Candice Y.1,Galindo Rodolfo J.2ORCID,Navarrete Jose E.3,Zabala Zohyra2ORCID,Moazzami Bobak2,Gerges Amany2,McCoy Rozalina G.45ORCID,Fayfman Maya2ORCID,Vellanki Priyathama2ORCID,Idrees Thaer2ORCID,Peng Limin6,Umpierrez Guillermo E.2ORCID

Affiliation:

1. 1Emory University School of Medicine, Atlanta, GA

2. 2Division of Endocrinology, Department of Medicine, Emory University, Atlanta, GA

3. 3Division of Nephrology, Department of Medicine, Emory University, Atlanta, GA

4. 4Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD

5. 5University of Maryland Institute for Health Computing, Bethesda, MD

6. 6Emory University Rollins School of Public Health, Atlanta, GA

Abstract

OBJECTIVE Patients with diabetes and end-stage kidney disease (ESKD) may experience “burnt-out diabetes,” defined as having an HbA1c value <6.5% without antidiabetic therapy for >6 months. We aim to assess glycemic control by continuous glucose monitoring (Dexcom G6 CGM) metrics and glycemic markers in ESKD patients on hemodialysis with burnt-out diabetes. RESEARCH DESIGN AND METHODS In this pilot prospective study, glycemic control was assessed by continuous glucose monitoring (CGM), HbA1c measures, and glycated albumin and fructosamine measurements in patients with burnt-out diabetes (n = 20) and without a history of diabetes (n = 20). RESULTS Patients with burnt-out diabetes had higher CGM-measured daily glucose levels, lower percent time in the range 70–180 mg/dL, higher percent time above range (>250 mg/dL), and longer duration of hyperglycemia >180 mg/dL (hours/day) compared with patients without diabetes (all P < 0.01). HbA1c and fructosamine levels were similar; however, patients with burnt-out diabetes had higher levels of glycated albumin than did patients without diabetes. CONCLUSIONS The use of CGM demonstrated that patients with burnt-out diabetes have significant undiagnosed hyperglycemia. CGM and glycated albumin provide better assessment of glycemic control than do values of HbA1c and fructosamine in patients with ESKD.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference17 articles.

1. Centers for Disease Control and Prevention . National Diabetes Statistics Report website. 2022. Accessed 5 January 2023. Available from https://www.cdc.gov/diabetes/data/statistics-report/index.html

2. Diabetic kidney disease: a report from an ADA Consensus Conference;Tuttle;Diabetes Care,2014

3. 6. Glycemic targets: Standards of Care in Diabetes—2023;ElSayed;Diabetes Care,2023

4. Glycemic monitoring and management in advanced chronic kidney disease;Galindo;Endocr Rev,2020

5. Monitoring glycemic control in end-stage renal disease: what should be measured?;Selvin;Clin Chem,2017

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