Assessment of blood glucose variability by continuous monitoring as a therapy guide for patients with diabetic nephropathy on hemodialysis

Background Plasma glucose variability may confer a risk for development of chronic diabetic complications. Glycosylated hemoglobin (HbA1c) reflects average glucose level but not glucose variability, which is measured by mean amplitude of glycemic excursions (MAGEs) and continuous glucose monitoring (CGM). Aim To study glucose variability using CGM/MAGE compared with sugar profiles and to assess their value as a therapy guide in patients with diabetic nephropathy on hemodialysis. Patients and methods Group 1 included 50 patients with type 2 diabetes mellitus (T2DM) without diabetic nephropathy. Group 2 included 50 patients with T2DM with diabetic nephropathy. Group 3 included 50 patients with T2DM with diabetic nephropathy on hemodialysis. Measurements of fasting blood glucose, postprandial blood glucose, HbA1c, and glucose variability by MAGE and CGM were done. Results CGM showed significant blood glucose variability (amplitude>130 mg/dl in 40 patients=80% using CGM and in 45 patients=90% using MAGE) in dialysis group (group 3) in comparison with glucose variability in nondialysis groups (group 1+group 2) (amplitude>130 mg/dl in 20 patients=20% using either CGM or MAGE). Group 1 showed significant correlations between either CGM or MAGE and all sugar profiles. Group 2 showed significant correlations between CGM and MAGE with either fasting or postprandial blood glucose but not with HbA1c, whereas group 3 showed nonsignificant correlations between either CGM or MAGE and any of sugar profiles. Conclusion CGM/MAGE have high specificity and sensitivity to measure variability of sugar levels, especially in patients with diabetic nephropathy on hemodialysis or not, in which HbA1c may not be a reliable tool