Continuous glucose monitoring (CGM) use in people living with diabetes on maintenance dialysis: a retrospective audit and observational cohort study

Abstract

Background and hypothesis: The evidence surrounding the long-term benefits of continuous glucose monitoring (CGM) use in people with diabetes on maintenance dialysis remains limited. We investigated the potential benefits of CGM use on long-term glycaemic outcomes in this cohort. Methods: A retrospective audit and observational cohort study was undertaken across all hospitals within University Hospitals Birmingham (UHB) NHS Foundation Trust, United Kingdom (UK). Clinical records of 55 adults with diabetes on maintenance dialysis using CGM were accessed. Trends in glycaemic outcomes including haemoglobin A1C (HbA1C), time in range (TIR), time above range (TAR), time below range (TBR), glucose variability, glucose management indicator (GMI), and hypoglycaemic episodes, were recorded for all subjects. Data was analysed using IBM SPSS Statistics (Version 30). Results: CGM utilisation was limited to 6.9% of people with diabetes on maintenance dialysis. The median duration on CGM was 26 months (IQR = 19,31). The median TIR remained suboptimal at 38%, with only 18.2% (n = 10/55) achieving the recommended target of 70% for the general diabetic population. The hyperglycaemic burden was significant, as reflected by a high median TAR (26% for TAR-very high > 13.9 mmol/L, 28% for TAR-high 10.1–13.9 mmol/L) and raised mean GMI of 68.76 mmol/mol. 67.3% (n = 37/55) of our dialysis cohort experienced at least one hypoglycaemic episode during the last 14-days of CGM use. Only 29.1% (n = 16/55) had their insulin regimen changed while using CGM. There was a small but non-significant reduction in HbA1C of 0.3 mol/mol [95% CI -5.58, 6.18; p = 0.919] following CGM utilisation. Conclusion: Our findings demonstrate high glucose burden and variability in people with diabetes maintained on dialysis. Large-scale real-world studies are needed to understand how to utilise CGM data to guide treatment adjustments and to establish the benefits of CGM-use on other long-term clinical outcomes in this cohort.