Continuous glucose monitoring system in 72-hour glucose profile assessment in patients with end-stage renal disease on maintenance continuous ambulatory peritoneal dialysis.

BACKGROUND: Glucose has been the main osmole used in conventional peritoneal fluids (PDFs) since the beginning of continuous ambulatory peritoneal dialysis (CAPD). There is much concern regarding the possible risk to the good level of glycemia control lately observed. The aim of this study was to analyze, with the use of 72-hour continuous glucose monitoring system (CGMS), the influence of PDFs containing supra-physiological glucose concentrations on daily glucose profile in patients with end stage renal disease (ESRD) undergoing CAPD therapy. MATERIAL/METHODS: There were 30 diabetic and non-diabetic patients on CAPD using conventional 1.36% or 2.27% glucose PDFs examined in the study, with a control group of 13 healthy volunteers. All participants underwent 72-hour CGMS and HbA1c evaluation. There was the whole area under the curve (AUC) of each 24-hour glucose profile and of glucose excursion above 90 mg/dl estimated. RESULTS: The high transport status appeared to significantly influence the mean maximum glucose value and its increment following peritoneal exchange (PE) in the study group and in a subgroup of diabetic patients, whereas in non-diabetics the mean 24-hour glucose concentration was importantly influenced. The percentage of glucose levels in the range above 90 mg/dl was significantly influenced by higher glucose concentration in the PDFs, as well as higher peritoneal transport status. CONCLUSIONS: The outcomes indicate that dialysate glucose concentration, as well as type of peritoneal transport, influence the occurrence of persistent hyperglycemia state, and suggest that CAPD may predispose to appearance of glycemic disorders.

Mitogenic potency of insulin glargine.

The goal of diabetes mellitus treatment is to maintain long-term near-normoglycaemia to prevent the onset or progression of long-term complications. In order to achieve tight glycaemic control and improve the quality of life for diabetic patients, a number of novel insulin preparations, insulin analogues, have been constructed thanks to recombinant DNA technologies and advanced protein chemistry. Because structurally modified insulins may differ from human insulin not only in metabolic but also in mitogenic potencies there were concerns raised about the possibility of increased insulin analogue proliferative action or tumourigenesis. In vitro and in vivo studies on insulin analogues in comparison to endogenous insulin have been performed to closely monitor the insulin analogue action profiles. Insulin glargine was the only one presenting a significant increase in affinity to insulin-like growth factor type 1 (IGF-1) receptor. However, there was controversy regarding the safety of insulin glargine use because of its potential risk of mitogenicity but it proved to be true only for human osteosarcoma cells Saos/B10. Outcomes of the studies performed on lines other than cancer cells and on animals did not present any increased mitogenic activity nor mitogenic potency of insulin glargine in comparison to human insulin.