Details
Category: Volume 08 Issue 11 November 2020
Hits: 1027

Title: Glycemic variability among type 2 diabetes patients with chronic kidney disease (CKD) using continuous glucose monitoring: a study from a tertiary care hospital

Authors: Dr Prabhakar K, Dr M Sasi Sekhar, Dr Anitha A

 DOI: https://dx.doi.org/10.18535/jmscr/v8i11.32

Abstract

This study was designed to study the short term oscillations of glucose levels for a period of 3 days by using continuous glucose monitoring (CGM) as it uses glucose as a more important clinical tool, for a more definitive understanding of glycemic variability and its role in diabetic individuals with CKD and thus foreseeing the complications and its better management among high risk individuals.

Materials & Methods: Diabetic individuals > 18 years with chronic kidney disease attending outpatient and inpatient of SRI DEVARAJ MEDICAL COLLEGE and RL JALAPPA Hospital. Study Duration: 3 months. Study design: Hospital based observational study. Inclusion criteria: Adults with Type 2 Diabetes Mellitus and Diagnosed with CKD (Either Kidney damage or GFR<60ml/min/ 1.73m2 for ≥ 3 Months -NKF KDIOQI guidelines).Exclusion criteria: Adults with Diagnosed primary kidney diseases, Congenital/ Acquired anatomical defects of the kidney, Obstructive nephropathies, Pregnancy and lactation. Sampling method:  Purposive sampling, Sample size: - 50 subjects

Results: In our study 78% of the subjects were male and 22% of the subjects were female. In our study 94% of the subjects had hypertension, 46% of the subjects had CAD and 12% of the subjects had strokes. Multiple co-morbidities was present around 44% of the subjects.

Similar finding was present in our study majority of the subjects had stage 4 CKD.

In our study 46% were overweight, 22% of the subjects were in obesity class 1, 14% of the subjects were in obesity class 2 and only 18% of the subjects had normal weight.

Discussion: In our study MODD estimation of inter-day glucose variability which was significantly higher in CKD stage 4, 5 when compared with CKD stage 1, 2, 3. Inter day glucose variability increases as the CKD stage increases similar to a study done Cristina et al.

Keywords: Glycaemic variability, Chronic kidney disease, Continuous glucose monitoring system.

References

  1. Tuttle KR, Baris GL, Bilous RW, etal. Diabetic kidney disease: a report from an ADA consensus conference. Diabetes care. 2014;37(10):2864-2883
  2. Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control complications, and death in older diabetic patients: the diabetes and aging study. Diabetes care. 2011; 34(6): 1329-1336.
  3. Siegelaar SE, Holleman F, Hoekstra JB, De Vries JH, et al. Glucose variability; does it matter?. Endocr Rev (2010); 31:171-182.
  4. Monnier L, Colette C, et al. Glycemic variability: should we and can we prevent it? Diabetes care 2008; 31:S150-S154
  5. Modi GK, Jha V, et al. The incidence of end-stage renal disease in India: a population-based study. Kidney Int. 2006 Dec;70(12): 2131-2133
  6. Mohan M Rajapurkar, George T John, et al. What do we know about chronic kidney disease in India: first report of indian CKD registry. BMC nephrology 2012, 13:10.
  7. Pecoits-Filho R, Hugo Abensur, et al. Interactionsbetween kidney disease and diabetes: Dangerous liaisons. Diabetolmetabsyndr (2016); 8:50
  8. McCance DR, Clarke KC, Kennedy L. Serum fructosamine in uraemia, myeloma and acute inflammatory disorders- relationship to serum glucose and aklbumin levels. Ann ClinBiochem 1989; 26(pt 1): 63-68
  9. Morgan L, Monsod T, Deucia M, et al. Glycated proteins as indices of glycemic control in diabetic patients with chronic renal failure. Diabet Med 1996; 13: 514-519.
  10. Savitha Subramanian, Irl B. Hirsch. Diabetic kidney disease: Is there a role of glycemic variability?. Current Diabetes Reports(2018) ;18:13
  11. pediatria.umed.pl/team/glyculator. Accessed in June 2013
  12. Czerwoniuk D, Fendler W, Walenciak L, Mlynarski W. GlyCulator: a glycemic variability calculation tool for continuous glucose monitoring data. JDiabetesSciTechnol 5: 447-451, 2011.
  13. Wójcicki JM. Mathematical descriptions of theglucose control in diabetes therapy. Analysis of theSchlichtkrull "M"-value. HormMetab Res 27: 1-5, 1995.
  14. Molnar GD, Taylor WF, Ho MM. Day-to-day variation of continuously monitored glycaemia: a further measure of diabetic instability. Diabetologia8: 342-348,1972.
  15. Presswala L, Hong S, Harris Y, Romao I, Zhang M, Jhaveri KD, Sakhiya V, Fishbane S. Continuous Glucose Monitoring and Glycemic Control in Patients With Type 2 Diabetes Mellitus and CKD. Kidney Medicine. 2019 Sep 1;1(5):281-7.
  16. Văduva C, Popa S, Moţa M, Moţa E. Analysis of Chronic Kidney Disease–Asociated Glycemic Variability in Patients with Type 2 Diabetes Using Continuous Glucose Monitoring System. Romanian Journal of Diabetes Nutrition and Metabolic Diseases. 2013 Sep 1;20(3):315-22.
  17. Vos FE, Schollum JB, Coulter CV, Manning PJ, Duffull SB, Walker RJ. Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring. Nephrology\ (Carlton) 17: 182 -188, 2012.
  18. Kazempour-Ardebili S, Lecamwasam VL, Dassanyake T et al. Assessing glycemic control in maintenance hemodialysis patients with type 2 diabetes. Diabetes Care 32: 1137-1142, 2009.
  19. Riveline JP, Teynie J, Belmouaz S et al. Glycaemic control in type 2 diabetic patients on chronic haemodialysis: use of a continuous glucose monitoring system. Nephrol Dial Transplant 24: 2866-2871, 2009.

Corresponding Author

Dr M Sasi Sekhar

MBBS, MD General Medicine, Post Graduate