Reach Us +44-1202-068036

Abstract

High rate of asymptomatic hypoglycemia in insulin-treated diabetes with severe chronic kidney disease: Utility of flash interstitial glucose monitoring

Author(s): Connie Luo, Maria Ines Constantino, Margaret Joy McGill, Timothy Middleton, Ted Wu, Jencia Wong, Stephen Morris Twigg & P Jean Ho*

Objective: Insulin-treated diabetes patients with severe chronic kidney disease (CKD) commonly have reduced hypoglycemia awareness that can potentiate hypoglycemia risk. We assessed in such patients: whether flash interstitial glucose monitoring (iGM) measures correlate with capillary blood glucose (cBGL) levels, the prevalence of asymptomatic hypoglycemia, and if iGM usage may help decrease hypoglycemia occurrence.

Methods: Thirteen adult insulin-treated, CKD stage 4 or 5 diabetes patients with reduced hypoglycemia awareness, from a tertiary hospital diabetes renal clinic, participated in a familiarization program with Freestyle Libre Flash Glucose Monitoring for two 14-d periods (P), and insulin treatment was adjusted as indicated between periods.

Results: Initial HbA1c was 7.2 ± 1.4%. The iGM correlated with cBGL (n=480, r=0.86, p<0.0001). By Clarke error grid analysis: 93.3% of data points were in combined Zones A and B, and 4 data points in Zone E. All hypoglycemia (iGM or cBGL < 3.9 mM) was asymptomatic. More hypoglycemic events were detected by iGM than by cBGL (7.9 ± 7.8 events/14 d vs. 0.4 ± 0.8, iGM vs cBGL, p<0.01 in P1, 5.4 ± 3.6 events/14 d vs. 0.3 ± 0.6, iGM vs cBGL, p<0.001 in P2). Hypoglycemia time in P1, 6.2 ± 6.2% (0%-20.0%), and number of events, did not change in P2. Ten patients recorded hypoglycemia in P1: their time in hypoglycemia decreased from 8.0% ± 5.9% to 3.2% ± 2.8% (p=0.01) in P2.

Conclusions: In this patient group, iGM detected high rates of hypoglycemia; its use may help to decrease hypoglycemia and improve patient safety.


Share this
izmir bayan escort escort izmir bursa escort antalya escort kızlar izmir escort porno porno indir porno izle izmir escort bursa escort porno izle indir