Utilising continuous glucose monitoring for glycemic control in diabetic kidney disease

Abstract

In this editorial, we comment on the article by Zhang et al. Chronic kidney disease (CKD) presents a significant challenge in managing glycemic control, especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation. Conventional markers like glycated haemoglobin (HbA1c) may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction. This comprehensive review discusses the limitations of HbA1c and explores alternative methods, such as continuous glucose monitoring (CGM) in CKD patients. CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c. Key studies demonstrate the utility of CGM in different CKD settings, including hemodialysis and peritoneal dialysis patients, as well as kidney transplant recipients. Despite challenges like sensor accuracy fluctuation, CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo- and hyperglycemia, to which CKD patients are prone. The review also addresses the limitations of CGM in CKD patients, emphasizing the need for further research to optimize its utilization in clinical practice. Altogether, this review advocates for integrating CGM into managing glycemia in CKD patients, highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.

Keywords: Chronic kidney disease; Diabetic kidney disease; Glycemic control; Continuous glucose monitoring; Glycated hemoglobin; Glycemic variability

Core Tip: Continuous glucose monitoring (CGM) emerges as a transformative tool, offering real-time insights into glycemic variability among diabetic patients with chronic kidney disease (CKD), particularly during dialysis and post-transplantation phases. Innovations include CGM's ability to accurately detect hyper- and hypoglycemic events, aiding in timely therapeutic adjustments to mitigate risks. Studies demonstrate CGM's superiority over traditional markers like glycated haemoglobin in capturing acute glycemic fluctuations, particularly in dialysis patients, mainly due to the shorter life span of red blood cells, besides maintaining accuracy across all CKD stages, including those on peritoneal dialysis. CGM has substantive potential in individualized glycaemic management of CKD.