High incidence of low interstitial fluid glucose among type 2 diabetes patients with chronic kidney disease (CKD) despite adhering to appropriate glycated haemoglobin targets—has time come for robust integration of interstitial fluid glucose targets into glycaemic guidelines?
Authors' conclusion
The CKD cohort has a greater burden of hypoglycaemia despite being treated to similar HbA1c targets. The greater number of nocturnal events warrants safety concern. Interstitial fluid glucose targets should be incorporated into the glycaemic guidelines for T2D patients with CKD.
Study context
- Population
- T2D subjects with and without CKD recruited from a tertiary-care hospital
- Participants
- 134 subjects
- Exposure
- T2D with CKD vs T2D without CKD
- CKDn = 74
- Non-CKDn = 60reference
- Outcome
- Burden of Level 1 (<4 mmol/L) and Level 2 (<3 mmol/L) hypoglycaemia
- Follow-up
- 2 weeks sensor wear
Methodological detailssingle-centre, tertiary-care hospital, 2-week CGM (Freestyle Libre-Pro)
- Single-centre
- Tertiary-care hospital
- 2-week CGM (Freestyle Libre-Pro)
Main finding
As reported in the abstract
2 weeks
Odds ratio
1.73
P = 0.011
Level 1 (<4 mmol/L) hypoglycaemia
Odds ratio
2.16
P = 0.002
Level 2 (<3 mmol/L) hypoglycaemia
Observational data: associations, not effects.
Further findings
HbA1c · no difference
P = 0.529
Glycaemic variability · 2 weeks
- Level 2 hypoglycaemia events, nocturnal vs day, within CKD cohort · 2-week sensor wear · CKD cohort: 1.9 ± 3.1 vs 1.4 ± 2.5 events/person
- P = 0.022
Glycaemic variability · 2 weeks
- Increased glycaemic variability in CKD vs non-CKD
Level 2 hypoglycaemia events, nocturnal vs day, within CKD cohort · 2-week sensor wear
- No significant intra-day difference in Level 2 events within non-CKD cohort
Original publication
High incidence of low interstitial fluid glucose among type 2 diabetes patients with chronic kidney disease (CKD) despite adhering to appropriate glycated haemoglobin targets—has time come for robust integration of interstitial fluid glucose targets into glycaemic guidelines? Diabet Med. Published 20 September 2024. doi:10.
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