Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Pushing Back the Curtain: CGM in Patients on Dialysis

Video Transcription

Video Summary

Dr. Ian DeBoer discusses whether continuous glucose monitoring (CGM) can help manage glycemia in dialysis patients, a group often overlooked because A1C is biased, hypoglycemia risk is high, and comorbidity burden is large. He reviews theoretical accuracy concerns—fluid shifts affecting interstitial glucose dynamics and assay interference (notably maltose from icodextrin in peritoneal dialysis)—but notes modern CGMs using glucose oxidase are less susceptible. Multiple studies in hemodialysis and peritoneal dialysis show clinically acceptable accuracy (most readings in safe error-grid zones), though MARD is often higher than in the general population and lag time may be longer. CGM reveals substantial unrecognized hyperglycemia, including in “burnt-out” or untreated diabetes, and shows distinct patterns such as post-hemodialysis glucose rebound. In a large cohort (BLOSUM), few dialysis patients with diabetes met time-in-range goals. Finally, small trials show CGM-linked closed-loop insulin systems can improve time-in-range without increasing hypoglycemia, supporting development of dialysis-specific treatment paradigms.

Asset Subtitle

Ian de Boer

Meta Tag

Module DKD

Speaker Ian de Boer

Keywords

continuous glucose monitoring (CGM)

dialysis patients glycemic management

hemodialysis glucose rebound

peritoneal dialysis icodextrin maltose interference

CGM accuracy MARD lag time

closed-loop insulin systems time-in-range