Continuous Glucose Monitoring Metrics and Hemoglobin A1c Relationship in Patients with Type 2 Diabetes Treated by Hemodialysis.
Rodolfo J Galindo, Bobak Moazzami, Katherine R Tuttle, Richard M Bergenstal, Limin Peng, Guillermo E Umpierrez
Author Information
Rodolfo J Galindo: Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA. ORCID
Bobak Moazzami: Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA.
Katherine R Tuttle: Division of Nephrology, Kidney Research Institute, and Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA.
Richard M Bergenstal: International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA. ORCID
Limin Peng: Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Guillermo E Umpierrez: Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA.
There is a need for accurate glycemic control metrics in patients with diabetes and end-stage kidney disease (ESKD). Hence, we assessed the relationship of continuous glucose monitoring (CGM) metrics and laboratory-measured hemoglobin A1c (HbA1c) in patients with type 2 diabetes (T2D) treated by hemodialysis. This prospective observational study included adults (age 18-80 years) with T2D (HbA1c 5%-12%), treated by hemodialysis (for at least 90 days). Participants used a Dexcom G6 Pro CGM for 10 days. Correlation analyses between CGM metrics [mean glucose, glucose management indicator (GMI), and time-in-range (TIR 70-180 mg/dL)] and HbA1c were performed. Among 59 participants (mean age was 57.7 ± 9.3 years, 58% were female, 86% were non-Hispanic blacks), the CGM mean glucose level was 188.9 ± 45 mg/dL (95% CI: 177.2, 200.7), the mean HbA1c and GMI were 7.1% ± 1.3% and 7.8% ± 1.1%, respectively (difference 0.74% ± 0.95). GMI had a strong negative correlation with TIR 70-180 mg/dL (r = -0.96). The correlation between GMI and HbA1c (r = 0.68) was moderate. Up to 29% of participants had a discordance between HbA1c and GMI of <0.5%, with 22% having a discordance between 0.5% and 1%, and 49% having a discordance of >1%. In patients with diabetes and ESKD treated by hemodialysis, the GMI has a strong correlation with TIR, while HbA1c underestimated the average glucose and GMI. Given the limitations of HbA1c in this population, GMI or mean glucose and TIR may be considered as more appropriate glucose control markers.
