Blood Sugar Sensing on Maintenance Dialysis

University Of Washington, Seattle WA

Investigators

Linked publications & trials

Abstract

ABSTRACT Hyperglycemia is the cardinal manifestation of diabetes mellitus and an established risk factor for kidney failure, retinopathy, neuropathy, and cardiovascular disease in the general diabetes population. However, with dialysis, measurement and management of glycemia is notoriously difficult, due in part to known inaccuracies of hemoglobin A1c. In addition, severe hypoglycemia is common in dialysis patients with and without diabetes. As a result, relationships of glycemia with clinical outcomes and unique determinants of glycemia are poorly defined in the dialysis population. These knowledge gaps preclude development of informed therapeutic strategies. We initiated the BLOod Sugar Sensing On Maintenance dialysis (BLOSSOM) study to better characterize glycemia in the dialysis population using continuous glucose monitoring (CGM). In our initial funding period, we observed high rates of hypoglycemia, but uncontrolled hyperglycemia was surprisingly predominant. In particular, we observed remarkably poor glycemic control among dialysis patients with treated diabetes, despite reasonable clinical hemoglobin A1c measurements, as well as substantial hyperglycemia among participants with untreated diabetes (who may assume their diabetes is no longer a problem) and among nondiabetic participants treated with peritoneal dialysis. In this competitive renewal application, we propose to extend our initial observations to better define the determinants and consequences of hyperglycemia and hypoglycemia in the dialysis population and advance appropriate application of CGM in this high-risk group. Specifically, we aim to: (1) test associations of glycemia, measured by CGM, with long-term clinical outcomes in kidney failure treated with dialysis by expanding and extending the BLOSSOM cohort and linking with a comprehensive outcome ascertainment resource; (2) determine the physiologic underpinnings of the extensive, unanticipated hyperglycemia observed in BLOSSOM by linking frequently- sampled oral glucose tolerance tests to CGM patterns in a subset of BLOSSOM participants; and (3) develop novel analytic approaches to improve CGM interpretation and application. Together, this work will advance understanding of the physiologic basis and health implications of abnormal glycemia in the dialysis population and provide a foundation for clinical application of CGM and for clinical trials of new therapeutic strategies.