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Continuous Glucose Monitoring Metrics in the Assessment of Glycemia in Moderate-to-Advanced CKD in Diabetes
INTRODUCTION: Glycated hemoglobin A1c (HbA1c) has reduced reliability in advanced chronic kidney disease (CKD) owing to factors influencing red cell turnover. Recent guidelines support the use of continuous glucose monitoring (CGM) in glycemic assessment in these patients. We evaluated relationships...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9171696/ https://www.ncbi.nlm.nih.gov/pubmed/35685309 http://dx.doi.org/10.1016/j.ekir.2022.03.029 |
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author | Ling, James Ng, Jack K.C. Chung Lau, Eric S.H. Ma, Ronald C.W. Kong, Alice P.S. Luk, Andrea O.Y. Kwok, Jeffrey S.S. Szeto, Cheuk-Chun Chan, Juliana C.N. Chow, Elaine |
author_facet | Ling, James Ng, Jack K.C. Chung Lau, Eric S.H. Ma, Ronald C.W. Kong, Alice P.S. Luk, Andrea O.Y. Kwok, Jeffrey S.S. Szeto, Cheuk-Chun Chan, Juliana C.N. Chow, Elaine |
author_sort | Ling, James |
collection | PubMed |
description | INTRODUCTION: Glycated hemoglobin A1c (HbA1c) has reduced reliability in advanced chronic kidney disease (CKD) owing to factors influencing red cell turnover. Recent guidelines support the use of continuous glucose monitoring (CGM) in glycemic assessment in these patients. We evaluated relationships between HbA1c and CGM metrics of average glycemia and glucose variability (GV) in moderate-to-advanced CKD. METHODS: There were a total of 90 patients with diabetes in CKD stages G3b (n = 33), G4 (n = 43), and G5 (nondialysis) (n = 14) (age [mean ± SD] 65.4 ± 9.0 years, estimated glomerular filtration rate [eGFR] 26.1 ± 9.6 ml/min per 1.73 m(2), and HbA1c 7.4 ± 0.8%). CGM metrics were estimated from blinded CGM (Medtronic Ipro2 with Enlite sensor) and compared with HbA1c in the same week. RESULTS: Correlations between glucose management indicator (GMI) and HbA1c attenuated with advancing CKD (G3b [r = 0.68, P < 0.0001], G4 [r = 0.52, P < 0.001], G5 [r = 0.22, P = 0.44], P = 0.01 for CKD stage). In G3b and G4, HbA1c correlated significantly with time-in-range (TIR) (3.9–10.0 mmol/l) (r = −0.55 and r = −0.54, respectively) and % time > 13.9 mmol/l (r = 0.53 and r = 0.44, respectively), but not in G5. HbA1c showed no correlation with % time <3.0 mmol/l (r = −0.045, P = 0.67) or % coefficient of variation (CV) (r = −0.05, P = 0.64) in any CKD stage. Only eGFR was a significant determinant of bias for the difference between GMI and HbA1c (difference −0.28%, 95% CI [−0.52 to −0.03] per 15 ml/min per 1.73 m(2) decrement, P = 0.03). CONCLUSION: CGM-derived indices might serve as an adjunct to HbA1c monitoring to guide glycemic management, especially in those with eGFR <30 ml/min per 1.73 m(2). Time in hypoglycemia and glycemic variability are relevant glycemic targets for optimization not reflected by HbA1c. |
format | Online Article Text |
id | pubmed-9171696 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-91716962022-06-08 Continuous Glucose Monitoring Metrics in the Assessment of Glycemia in Moderate-to-Advanced CKD in Diabetes Ling, James Ng, Jack K.C. Chung Lau, Eric S.H. Ma, Ronald C.W. Kong, Alice P.S. Luk, Andrea O.Y. Kwok, Jeffrey S.S. Szeto, Cheuk-Chun Chan, Juliana C.N. Chow, Elaine Kidney Int Rep Clinical Research INTRODUCTION: Glycated hemoglobin A1c (HbA1c) has reduced reliability in advanced chronic kidney disease (CKD) owing to factors influencing red cell turnover. Recent guidelines support the use of continuous glucose monitoring (CGM) in glycemic assessment in these patients. We evaluated relationships between HbA1c and CGM metrics of average glycemia and glucose variability (GV) in moderate-to-advanced CKD. METHODS: There were a total of 90 patients with diabetes in CKD stages G3b (n = 33), G4 (n = 43), and G5 (nondialysis) (n = 14) (age [mean ± SD] 65.4 ± 9.0 years, estimated glomerular filtration rate [eGFR] 26.1 ± 9.6 ml/min per 1.73 m(2), and HbA1c 7.4 ± 0.8%). CGM metrics were estimated from blinded CGM (Medtronic Ipro2 with Enlite sensor) and compared with HbA1c in the same week. RESULTS: Correlations between glucose management indicator (GMI) and HbA1c attenuated with advancing CKD (G3b [r = 0.68, P < 0.0001], G4 [r = 0.52, P < 0.001], G5 [r = 0.22, P = 0.44], P = 0.01 for CKD stage). In G3b and G4, HbA1c correlated significantly with time-in-range (TIR) (3.9–10.0 mmol/l) (r = −0.55 and r = −0.54, respectively) and % time > 13.9 mmol/l (r = 0.53 and r = 0.44, respectively), but not in G5. HbA1c showed no correlation with % time <3.0 mmol/l (r = −0.045, P = 0.67) or % coefficient of variation (CV) (r = −0.05, P = 0.64) in any CKD stage. Only eGFR was a significant determinant of bias for the difference between GMI and HbA1c (difference −0.28%, 95% CI [−0.52 to −0.03] per 15 ml/min per 1.73 m(2) decrement, P = 0.03). CONCLUSION: CGM-derived indices might serve as an adjunct to HbA1c monitoring to guide glycemic management, especially in those with eGFR <30 ml/min per 1.73 m(2). Time in hypoglycemia and glycemic variability are relevant glycemic targets for optimization not reflected by HbA1c. Elsevier 2022-04-06 /pmc/articles/PMC9171696/ /pubmed/35685309 http://dx.doi.org/10.1016/j.ekir.2022.03.029 Text en © 2022 International Society of Nephrology. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Research Ling, James Ng, Jack K.C. Chung Lau, Eric S.H. Ma, Ronald C.W. Kong, Alice P.S. Luk, Andrea O.Y. Kwok, Jeffrey S.S. Szeto, Cheuk-Chun Chan, Juliana C.N. Chow, Elaine Continuous Glucose Monitoring Metrics in the Assessment of Glycemia in Moderate-to-Advanced CKD in Diabetes |
title | Continuous Glucose Monitoring Metrics in the Assessment of Glycemia in Moderate-to-Advanced CKD in Diabetes |
title_full | Continuous Glucose Monitoring Metrics in the Assessment of Glycemia in Moderate-to-Advanced CKD in Diabetes |
title_fullStr | Continuous Glucose Monitoring Metrics in the Assessment of Glycemia in Moderate-to-Advanced CKD in Diabetes |
title_full_unstemmed | Continuous Glucose Monitoring Metrics in the Assessment of Glycemia in Moderate-to-Advanced CKD in Diabetes |
title_short | Continuous Glucose Monitoring Metrics in the Assessment of Glycemia in Moderate-to-Advanced CKD in Diabetes |
title_sort | continuous glucose monitoring metrics in the assessment of glycemia in moderate-to-advanced ckd in diabetes |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9171696/ https://www.ncbi.nlm.nih.gov/pubmed/35685309 http://dx.doi.org/10.1016/j.ekir.2022.03.029 |
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