Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Panel Discussion: Case Studies in CGM Interpretation

Video Transcription

Video Summary

The session transitions into a case-based panel discussion focused on diabetes assessment and management in advanced kidney disease and transplant settings, emphasizing how standard metrics can mislead.<br /><br />Case 1: A 36-year-old woman labeled as type 1 diabetes since childhood has atypical features: negative antibodies, measurable C-peptide, and kidney disease present at diagnosis. These “red flags” prompt genetic testing, confirming an HNF1B splice mutation (monogenic/MODY-related diabetes) associated with pancreatic atrophy and characteristic kidney disease. The panel notes diagnostic pitfalls, including that C-peptide is renally cleared and can be elevated in low GFR, complicating interpretation in ESRD.<br /><br />Case 2: A 56-year-old Pacific Islander woman on dialysis has “normal” lab glucose and A1C (5.8%), yet CGM shows marked hyperglycemia (average 228 mg/dL; GMI 8.8%; time-in-range 32%). ESA therapy and timing of lab draws (during dialysis) likely bias A1C and spot glucose downward. The panel discusses using CGM to guide treatment, stressing pre-transplant diabetes optimization, and considering basal insulin, diet changes, and possibly GLP-1 therapies.<br /><br />Case 3: A recent kidney transplant recipient on prednisone has daytime steroid-driven hyperglycemia. CGM-guided adjustment of prandial insulin anticipates steroid tapering; later transition to a DPP-4 inhibitor maintains control as steroids decrease and kidney function stabilizes.

Asset Subtitle

FACULTY FACULTY

Meta Tag

Module DKD

Speaker FACULTY FACULTY

Keywords

diabetes management in chronic kidney disease

kidney transplant post-transplant hyperglycemia

MODY HNF1B mutation diagnosis

C-peptide interpretation in ESRD

A1C limitations with dialysis and ESA therapy

continuous glucose monitoring in dialysis patients

steroid-induced hyperglycemia insulin adjustment