960-P: Hemodialysis-Related Glycemic Patterns among People with Insulin-Treated Type 2 (T2D) Diabetes—Role of Continuous Glucose Monitoring (CGM)

Background: Hemodialysis (HD) impacts glucose and insulin metabolism and increases hypoglycaemia rates. Glucose-containing dialysate decreases the risk, but studies using CGM metrics are lacking. Methods: Prospective observational study of insulin-treated adults with T2D, receiving hemodialysis (dialysate glucose 100mg/dl), at least thrice weekly. Subjects were instructed to wear a Dexcom G6-Pro for 10 days. We assessed CGM metrics (mean glucose, %TIR, %TAR, %TBR, and hypoglycemic and hyperglycemic rates) during three time periods: 20-hours before (PreHD), during (HD, ~4 hours), and 20-hours after (PostHD) hemodialysis sessions. Results: Among 56 subjects (mean age 57.3±9, HbA1c 7.2±1.4), mean glucose, %TAR, %TIR and rates of hypoglycaemia \u3c70mg/dl were significantly better during HD. %TAR \u3e180mg/dl and \u3e 250mg/dl were significantly higher after HD, see Table 1. Other hypoglycaemia metrics were overall low, and not different in relation to HD timing. Conclusion: CGM patterns demonstrated improved glycemic control during dialysis, with tendency for higher glucose metrics before HD. Hypoglycaemia metrics were low, while severe hyperglycemia excursions are common across all HD-related periods. Future studies using newer CGM technology and providing longer duration of CGM monitoring are needed for subjects with T2D treated by HD