Analysis of Glycemic Improvement in Hemodialysis Patients Based on Time in Range, Assessed by Flash Glucose Monitoring

Abstract

<b><i>Introduction:</i></b> This study aimed to investigate the application value of “time in ranges (TIRs)” in dialysis patients with diabetes and summarize the experience of optimizing glycemic control by flash glucose monitoring (FGM) system. <b><i>Methods:</i></b> In this monocentric 2-week pilot study, FGM was applied for 14 days in 57 type 2 diabetes mellitus medically stable patients under maintenance hemodialysis to determine their glycemic improvement. The diagnostic value of TIR versus HbA1c in detecting glucose fluctuations and levels was evaluated using receiver operating characteristic analysis. <b><i>Results:</i></b> Average glucose exhibited stronger association with TIR (<i>r</i> = −0.785, <i>p</i> &#x3c; 0.001) than HbA1c (<i>r</i> = 0.644, <i>p</i> &#x3c; 0.001), and mean amplitude of glycemic excursion (MAGE) had the same conclusion (<i>r</i> = −0.568, <i>p</i> &#x3c; 0.001 for TIR vs. <i>r</i> = 0.423, <i>p</i> = 0.016 for HbA1c). TIR exhibited a higher area under curve than HbA1c in detecting significant derangements in glucose fluctuation, using a 14-day average FGM-derived coefficient of variation &#x3e;36% as the reference standard (difference between areas: 0.237; 95% CI 0.092–0.383, <i>p</i> = 0.001). We found a significant improvement in TIR (58.38 ± 19.42 vs. 46.45 ± 24.42 mmol/L, <i>p</i> &#x3c; 0.001) and a significant decline in MAGE (median 5.64 vs.7.42 mmol/L, <i>p</i> &#x3c; 0.001) compared to the baseline without deterioration of time spent in hypoglycemia. <b><i>Conclusion:</i></b> TIR seems to be feasible and clinically useful for AGP analysis in dialysis patients with diabetes, and FGM can be used to improve glycemic control.