RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/a-1978-0226
Accuracy of Flash Glucose Monitoring in Hemodialysis Patients With and Without Diabetes Mellitus
Funding This investigator-initiated study did not receive any external funding.
Abstract
Aims Glucose and insulin metabolism are altered in hemodialysis patients, and diabetes management is difficult in these patients. We aimed to validate flash glucose monitoring (FGM) in hemodialysis patients with and without diabetes mellitus as an attractive option for glucose monitoring not requiring regular self-punctures.
Methods We measured interstitial glucose using a FreeStyle Libre device in eight hemodialysis patients with and seven without diabetes mellitus over 14 days and compared the results to simultaneously performed self-monitoring of capillary blood glucose (SMBG).
Results In 720 paired measurements, mean flash glucose values were significantly lower than self-measured capillary values (6.17±2.52 vs. 7.15±2.41 mmol/L, p=1.3 E-86). Overall, the mean absolute relative difference was 17.4%, and the mean absolute difference was 1.20 mmol/L. The systematic error was significantly larger in patients without vs. with diabetes (− 1.17 vs. − 0.82 mmol/L) and on dialysis vs. interdialytic days (−1.09 vs. −0.90 mmol/L). Compared to venous blood glucose (72 paired measurements), the systematic error of FGM was even larger (5.89±2.44 mmol/L vs. 7.78±7.25 mmol/L, p=3.74E-22). Several strategies to reduce the systematic error were evaluated, including the addition of +1.0 mmol/L as a correction term to all FGM values, which significantly improved accuracy.
Conclusions FGM systematically underestimates blood glucose in hemodialysis patients but, taking this systematic error into account, the system may be useful for glucose monitoring in hemodialysis patients with or without diabetes.
Key words
Hemodialysis - flash glucose monitoring - glucose monitoring - interstitial fluid glucose level - diabetes mellitus - FreeStyle LibrePublikationsverlauf
Eingereicht: 16. Februar 2022
Eingereicht: 27. April 2022
Angenommen: 13. Oktober 2022
Accepted Manuscript online:
14. November 2022
Artikel online veröffentlicht:
18. Januar 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Koye DN, Magliano DJ, Nelson RG. et al. The global epidemiology of diabetes and kidney disease. Adv Chronic Kidney Dis 2018; 25: 121-132
- 2 ERA-EDTA Registry: ERA-EDTA Registry Annual Report 2019. Amsterdam UMC, location AMC, Department of Medical Informatics, Amsterdam, the Netherlands, 2021.
- 3 Rahhal M-N, Gharaibeh NE, Rahimi L. et al. Disturbances in insulin –glucose metabolism in patients with advanced renal disease with and without diabetes. J Clin Endocrinol Metab 2019; 104: 4949-4966
- 4 Sobngwi E, Ashuntantang G, Ndounia E. et al. Continuous interstitial glucose monitoring in non-diabetic subjects with end-stage renal disease undergoing maintenance haemodialysis. Diabetes Res Clin Pract 2010; 90: 22-25
- 5 Castellana M, Parisi C, Di Molfetta S. et al. Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2020; 8: e001092
- 6 Bailey T, Bode BW, Christiansen MP. et al. The performance and usability of a factory-calibrated flash glucose monitoring system. Diabetes Technol Ther 2015; 17: 787-794
- 7 Haak T, Hanaire H, Ajjan R. et al. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: A multicenter, open-label randomized controlled trial. Diabetes Ther 2017; 8: 55-73
- 8 Cappon G, Vettoretti M, Sparacino G. et al. Continuous glucose monitoring sensors for diabetes management: A review of technologies and applications. Diabetes Metab J 2019; 43: 383-397
- 9 Hoss U, Budiman ES.. Factory-calibrated continuous glucose sensors: The science behind the technology. Diabetes Technol Ther 2017; 19: 44-50
- 10 Joubert M, Fourmy C, Henri P. et al. Effectiveness of continuous glucose monitoring in dialysis patients with diabetes: The DIALYDIAB pilot study. Diabetes Res Clin Pract 2015; 107: 348-354
- 11 Yeoh E, Lim BK, Fun S. et al. Efficacy of self-monitoring of blood glucose versus retrospective continuous glucose monitoring in improving glycaemic control in diabetic kidney disease patients. Nephrology 2018; 23: 264-268
- 12 Riveline J-P, Teynie J, Belmouaz S. et al. Glycaemic control in type 2 diabetic patients on chronic haemodialysis: Use of a continuous glucose monitoring system. Nephrol Dial Transplant 2009; 24: 2866-2871
- 13 Klonoff DC, Ahn D, Drincic A.. Continuous glucose monitoring: A review of the technology and clinical use. Diabetes Res Clin Pract 2017; 133: 178-192
- 14 Buckingham B.. Clinical overview of continuous glucose monitoring. J Diabetes Sci Technol 2008; 2: 300-306
- 15 Mian Z, Hermayer KL, Jenkins A.. Continuous glucose monitoring: Review of an innovation in diabetes management. Am J Med Sci 2019; 358: 332-339
- 16 FreeStyle Libre. FreeStyle Libre System. n.d https://www.freestyle.abbott/ch-de/produkte.html
- 17 Gosmanov AR, Gosmanova EO, Kovesdy CP.. Evaluation and management of diabetic and non-diabetic hypoglycemia in end-stage renal disease. Nephrol Dial Transplant 2016; 31: 8-15
- 18 Bossola M, Tazza L.. Postdialysis fatigue: A frequent and debilitating symptom. Semin Dial 2016; 29: 222-227
- 19 Raju SF, White AR, Barnes TT. et al. Improvement in disequilibrium symptoms during dialysis with low glucose dialyzate. Clin Nephrol 1982; 18: 126-129
- 20 Leski M, Niethammer T, Wyss T.. Glucose-enriched dialysate and tolerance to maintenance hemodialysis. Nephron 1979; 24: 271-273
- 21 Feldman B, Brazg R, Schwartz S. et al. Trial in patients with type 1 diabetes. Diabetes Technol Ther 2003; 5: 769-779
- 22 Klonoff DC, Lias C, Vigersky R. et al. The surveillance error grid. J Diabetes Sci Technol 2014; 8: 658-672
- 23 Freckmann G, Pleus S, Link M. et al. In Accuracy of BG Meters and CGM Systems: Possible Influence Factors for the Glucose Prediction Based on Tissue Glucose Concentrations 2016; 31-42
- 24 Fokkert MJ, van Dijk PR, Edens MA. et al. Performance of the FreeStyle Libre Flash glucose monitoring system in patients with type 1 and 2 diabetes mellitus. BMJ Open Diabetes Res Care 2017; 5: e000320
- 25 Ólafsdóttir AF, Attvall S, Sandgren U. et al. A clinical trial of the accuracy and treatment experience of the flash glucose monitor FreeStyle Libre in adults with type 1 diabetes. Diabetes Technol Ther 2017; 19: 164-172
- 26 Freckmann G, Link M, Pleus S. et al. Measurement Performance of Two Continuous Tissue Glucose Monitoring Systems Intended for Replacement of Blood Glucose MonitoringParts of the data have previously been presented at the 77th Scientific Sessions of the American Diabetes Association in San Di. Diabetes Technol Ther 2018; 20: 541-549
- 27 Chen C, Zhao X-L, Li Z-H. et al. Current and emerging technology for continuous glucose monitoring. Sensors 2017; 17: 182
- 28 Aberer F, Hajnsek M, Rumpler M. et al. Evaluation of subcutaneous glucose monitoring systems under routine environmental conditions in patients with type 1 diabetes. Diabetes, Obes Metab 2017; 19: 1051-1055
- 29 Galindo RJ, Migdal AL, Davis GM. et al. Comparison of the FreeStyle Libre pro flash continuous glucose monitoring (CGM) system and point-of-care capillary glucose testing in hospitalized patients with type 2 diabetes treated with basal-bolus insulin regimen. Diabetes Care 2020; 43: 2730-2735
- 30 Javherani R, Purandare V, Bhatt A. et al. Flash glucose monitoring in subjects with diabetes on hemodialysis: A pilot study. Indian J Endocrinol Metab 2018; 22: 848
- 31 Ushigome E, Matsusaki S, Watanabe N. et al. Critical discrepancy in blood glucose control levels evaluated by glycated albumin and estimated hemoglobin A1c levels determined from a flash continuous glucose monitoring system in patients with type 2 diabetes on hemodialysis. J Diabetes Investig 2020; 11: 1570-1574
- 32 Hu K, Peng H, Ma Y. et al. Analysis of glycemic improvement in hemodialysis patients based on time in range, assessed by flash glucose monitoring. Blood Purif 2021; 50: 883-890
- 33 Matoba K, Hayashi A, Shimizu N. et al. Comparison of accuracy between flash glucose monitoring and continuous glucose monitoring in patients with type 2 diabetes mellitus undergoing hemodialysis. J Diabetes Complications 2020; 34: 107680
- 34 Yajima T, Takahashi H, Yasuda K.. Comparison of interstitial fluid glucose levels obtained by continuous glucose monitoring and flash glucose monitoring in patients with type 2 diabetes mellitus undergoing hemodialysis. J Diabetes Sci Technol 2020; 14: 1088-1094
- 35 Genua I, Sánchez-Hernandez J, Martínez MJ. et al. Accuracy of flash glucose monitoring in patients with diabetes mellitus on hemodialysis and its relationship with hydration status. J Diabetes Sci Technol 2021; 15: 1308-1312
- 36 Bonora B, Maran A, Ciciliot S. et al. Head-to-head comparison between flash and continuous glucose monitoring systems in outpatients with type 1 diabetes. J Endocrinol Invest 2016; 39: 1391-1399
- 37 Gosmanov AR.. A practical and evidence-based approach to management of inpatient diabetes in non-critically ill patients and special clinical populations. J Clin Transl Endocrinol 2016; 5: 1-6