Efficacy of self‐monitoring of blood glucose versus retrospective continuous glucose monitoring in improving glycaemic control in diabetic kidney disease patients. Issue 3 (20th February 2018)

• Record Type: Journal Article
• Authors: Yeoh, Ester; Lim, Boon Khim; Fun, Sharon; Tong, Julia; Yeoh, Lee Ying; Sum, Chee Fang; Subramaniam, Tavintharan; Lim, Su Chi
• Is Part Of: Nephrology. Volume 23:Issue 3(2018)
• Page Start: 264
• Page End: 268
• Publication Date: 2018-02-20
• Subjects: continuous glucose monitoring -- diabetic nephropathy -- glycaemic control -- hypoglycaemia -- self‐monitoring of blood glucose; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.12978
• Languages: English
• ISSNs: 1320-5358

Abstract

Abstract: Aims: Patients with diabetic kidney disease (DKD) on anti‐diabetic agents, are at greater risk of glycemic variations, both hypoglycemia and hyperglycemia. We aimed to compare glycemic control (using HbA1c) and hypoglycemia incidence in patients with Stage 3 DKD (eGFR 30–60 mL/min per 1.73 m 2 ), receiving retrospective CGM‐guided anti‐diabetic therapy versus self‐monitoring of blood glucose (SMBG) over 3 months. Methods: Thirty patients with HbA1c >8% were randomized to 6‐day retrospective CGM or SMBG. In the CGM group, CGM was worn at the beginning and 6 weeks. HbA1c, assessment of hypoglycaemia events (self‐reported and BG < 4 mmol/L from CGM/SMBG data) and medication adjustment were performed at baseline and 3 months. All patients received education on hypoglycaemia avoidance. Results: Fourteen patients were allocated to CGM and 16 to SMBG. Mean (±SD) eGFR was 42.9 ± 10.3 mL/min. Majority (86.7%) of patients had diabetes duration >10 years and on insulin therapy (90%). HbA1c improved significantly from baseline 9.9 ± 1.2 to 9.0 ± 1.5% ( P < 0.001) at 3 months, with no difference between CGM (9.8 ± 1.2 to 8.8 ± 1.8%, P = 0.009) or SMBG (9.9 ± 1.3 to 9.1 ± 1.1%, P = 0.007) groups ( P = 0.869 between groups). In the CGM group, percentage duration in hyperglycaemia (BG > 10 mmol/L) reduced from baseline 65.4 ± 22.4% to 54.6 ± 23.6% ( P = 0.033) at 6 weeks, with a non‐significant rise in percentage duration in hypoglycaemia from 1.2 ± 2.2% to 4.0 ± 7.0% ( P = 0.176). There was no difference in self‐reported and documented hypoglycaemia events. Conclusion: In a pilot study of DKD patients, short‐term episodic use of CGM reduced time spent in hyperglycaemia range without significantly increasing time‐exposure to hypoglycaemia. However, both CGM and SMBG were equally effective in improving glycaemic control. Summary at a Glance: This paper examines an important aspect of glycaemic control monitoring in CKD patients. This population is at high risk for hypoglycaemia and there is a need for information on improved methods of monitoring and control for optimal outcomes. This paper compares two existent methods for glycaemic control monitoring.