Moritsugu Kimura, Masao Toyoda, Nobumichi Saito, Yosuke Nakagawa and Masafumi Fukagawa
Objective: Diabetic patients on hemodialysis (HD) are prone to develop treatment-related serious hypoglycemia due to poor renal clearance of insulin and augmented drug efficacy, often resulting in withdrawal of insulin. Consequently, many patients are erroneously switched to oral glucose-lowering agents or diet therapy alone, without self-monitoring of blood glucose (SMBG). Therefore, we hypothesized that continuous glucose monitoring (CGM) may be useful for optimizing glycemic control and clinical management in diabetic patients on HD. Methods: In this study, 8 type 2 diabetic patients on HD who did not use SMBG after withdrawal of insulin and start of oral glucose-lowering agents, were recruited to measure and evaluate blood glucose with CGM. These patients thought to be controlled within glycemic control target proposed by the Japanese Society for Dialysis Therapy. Predialysis casual plasma glucose level (or 2-h postprandial plasma glucose level) of <180-200 mg/dL and GA level <20.0%. Results: Although the levels of glycated albumin (GA) and blood glucose measured just before HD were within the provisional target values recommended by the Japanese Society for Dialysis Therapy in all eight patients, seven patients developed postprandial hyperglycemia (>200 mg/dl) after HD. Conclusions: Diabetic patients on HD require careful monitoring with SMBG, CGM, and direct measurement of postprandial blood glucose level during HD before any decision is made regarding withdrawal of insulin and cessation of SMBG.