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

Document Type


Publication Date

Spring 6-20-2023

Publication Title



washington; spokane; pmrc


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 <70mg/dl were significantly better during HD. %TAR >180mg/dl and > 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.


R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. B.Moazzami: None. A.Y.G.Gerges: None. L.Peng: None. K.R.Tuttle: Consultant; Lilly, AstraZeneca, Gilead Sciences, Inc., Research Support; Bayer Inc., Boehringer Ingelheim (Canada) Ltd., Novo Nordisk, Goldfinch Bio, Inc., Traveere Pharmaceuticals. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter.

Clinical Institute

Kidney & Diabetes