<b>OBJECTIVE</b>
<p>There is a high risk of asymptomatic hypoglycemia
associated with hemodialysis (HD) using glucose-free dialysate; therefore, the
inclusion of glucose in the dialysate is believed to prevent intradialytic
hypoglycemia. However, the exact glycemic fluctuation profiles and frequency of
asymptomatic hypoglycemia using dialysates containing >100 mg/dL glucose
have not been determined.</p>
<p><b>RESEARCH
DESIGN AND METHODS</b></p>
<p>We evaluated the glycemic profiles of 98 type 2 diabetes
patients undergoing HD (68 men, HbA1c 6.4±1.2%, glycated albumin 20.8±6.8%)
with a dialysate containing 100, 125, or 150 mg/dL glucose using continuous
glucose monitoring.</p>
<p><b>RESULTS</b></p>
<p>Sensor glucose level (SGL) showed a sustained decrease
during HD, irrespective of the dialysate glucose concentration, and reached a
nadir that was lower than the dialysate glucose concentration in 49 participants
(50%). Twenty-one participants (21%) presented with HD-related hypoglycemia,
defined by an SGL <70 mg/dL during HD and/or between the end of HD and their
next meal. All these hypoglycemic episodes were asymptomatic. Measures of
glycemic variability calculated using the SGL data (standard deviation,
coefficient of variation, and range of SGL) were higher and time below range
(<70 mg/dL) was lower in participants who experienced HD-related
hypoglycemia than in those who did not, whereas time in range between 70 and
180 mg/dL, time above range (>180 mg/dL), HbA1c and GA of the two groups
were similar.</p>
<p><b>CONCLUSIONS</b></p>
<p>Despite the use of dialysate containing 100–150 mg/dL
glucose, diabetic HD patients experienced HD-related hypoglycemia unawareness
frequently. SGL may fall well below the dialysate glucose concentration toward
the end of HD.<br>
</p>
Alternate glycemic markers reflect glycemic variability in continuous glucose monitoring in youth with prediabetes and type 2 diabetes