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CC BY-NC-ND 4.0 · Exp Clin Endocrinol Diabetes 2023; 131(03): 132-141
DOI: 10.1055/a-1978-0226
Article

Accuracy of Flash Glucose Monitoring in Hemodialysis Patients With and Without Diabetes Mellitus

Michèle R. Weber
1   Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
,
Matthias Diebold
2   Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel, Basel, Switzerland
,
Peter Wiesli
1   Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
,
Andreas D. Kistler
1   Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
› Author Affiliations Funding This investigator-initiated study did not receive any external funding.
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Abstract

Aims Glucose and insulin metabolism are altered in hemodialysis patients, and diabetes management is difficult in these patients. We aimed to validate flash glucose monitoring (FGM) in hemodialysis patients with and without diabetes mellitus as an attractive option for glucose monitoring not requiring regular self-punctures.

Methods We measured interstitial glucose using a FreeStyle Libre device in eight hemodialysis patients with and seven without diabetes mellitus over 14 days and compared the results to simultaneously performed self-monitoring of capillary blood glucose (SMBG).

Results In 720 paired measurements, mean flash glucose values were significantly lower than self-measured capillary values (6.17±2.52 vs. 7.15±2.41 mmol/L, p=1.3 E-86). Overall, the mean absolute relative difference was 17.4%, and the mean absolute difference was 1.20 mmol/L. The systematic error was significantly larger in patients without vs. with diabetes (− 1.17 vs. − 0.82 mmol/L) and on dialysis vs. interdialytic days (−1.09 vs. −0.90 mmol/L). Compared to venous blood glucose (72 paired measurements), the systematic error of FGM was even larger (5.89±2.44 mmol/L vs. 7.78±7.25 mmol/L, p=3.74E-22). Several strategies to reduce the systematic error were evaluated, including the addition of +1.0 mmol/L as a correction term to all FGM values, which significantly improved accuracy.

Conclusions FGM systematically underestimates blood glucose in hemodialysis patients but, taking this systematic error into account, the system may be useful for glucose monitoring in hemodialysis patients with or without diabetes.

Key words

Hemodialysis - flash glucose monitoring - glucose monitoring - interstitial fluid glucose level - diabetes mellitus - FreeStyle Libre

Supplementary Material



Publication History

Received: 16 February 2022
Received: 27 April 2022

Accepted: 13 October 2022

Accepted Manuscript online:
14 November 2022

Article published online:
18 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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