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Continuous Glucose Monitors Cut Hospitalizations in Type 2 Diabetes, CKD – Renal and Urology News

Implementing continuous glucose monitoring (CGM) reduces the number of both emergency visits and inpatient hospital stays among patients with type 2 diabetes and nondialysis-dependent chronic kidney disease (CKD), investigators report.

After starting CGM, which provides real-time glucose measurement every few minutes, rates of hospitalizations for hypoglycemic crises significantly decreased by 18.2% from 0.22 to 0.18 encounters per patient per year and hyperglycemic crises by 17.0% from 0.47 to 0.39 encounters per patient per year, Gregory J. Norman, PhD, of Dexcom, Inc. in San Diego, California, and colleagues reported in Kidney360. The proportion hospitalized with at least 1 hypoglycemic or hyperglycemic event also significantly decreased after CGM initiation.

The findings are from a study of 8959 insulin users with type 2 diabetes and stage 3-5 CKD from the 2016-2022 Optum Clinformatics© Database.

Significant predictors of a hypoglycemic encounter included a previous hypoglycemic crisis and age 30-59 years. Predictors of a hyperglycemic encounter included a previous hypoglycemic crisis, age 30-49 years, urinary incontinence, and cancer. Depression, heart failure, cerebrovascular disease, neuropathy, and pulmonary disease each significantly predicted both hypoglycemic and hyperglycemic crisis.

Most patients were taking intensive insulin (91.3%). Use of CGM significantly decreased the odds of hypoglycemic encounters by 23%, the investigators reported. Use of glucagon-like peptide-1 receptor agonists were protective against both hyperglycemia and hypoglycemia. Use of sulfonylureas protected against hyperglycemia.

A majority of patients (86.0%) had stage 3 CKD and were covered by Medicare (82.2%). Mean age was 68.6 years. Most patients were White (72.3%); Black, Hispanic, and Asian adults accounted for 15.1%, 9.6%, and 3.0%.

Dr Norman’s team encouraged earlier use of CGM to prevent diabetes complications.

“Proper monitoring of glycemic control is critical to slow the progression of CKD and reduce acute and chronic diabetes complications. This is commonly assessed through measurement of glycated hemoglobin (A1C), but the limitations of this assay are numerous. Anemia, erythropoiesis-stimulating agents, periodic blood transfusions, and the altered metabolic state associated with uremia can all contribute to erroneous A1C values.”

Disclosure: This research was supported by Dexcom. Please see the original reference for a full list of disclosures.

References:

Hannah KL, Nemlekar PM, Johnson ML, Cherñavvsky DR, Norman GJ. Continuous glucose monitors and reduced diabetes-related hospitalizations in patients with type 2 diabetes and chronic kidney disease. Kidney360. Published online February 15, 2024. doi:10.34067/KID.0000000000000396