Continuous glucose monitoring in diabetes patients with chronic kidney disease on dialysis: a meta-analysis.

INTRODUCTION: This review investigates the effectiveness of continuous glucose monitoring (CGM) in diabetes patients who were on routine dialysis. EVIDENCE ACQUISITION: Literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate: 1) correlations of CGM with other indicators including glycated hemoglobin A1c (HbA1c), glycated albumin and mean amplitude of glucose excursions (MAGE); 2) mean differences (MDs) in CGM and MAGE values between dialysis and off-dialysis days or during vs before dialysis. EVIDENCE SYNTHESIS: There was a good correlation between CGM and self-monitoring of blood glucose values (r=0.837 [95% CI: 0.67, 0.92]). Correlation coefficient between CGM and HbA1c was 0.523 (95% CI: 0.422, 0.604) in diabetes patients on dialysis and 0.592 (95% CI: 0.354, 0.757) in diabetes patients without renal failure. Correlation coefficient between CGM and glycated albumin in diabetes patients on dialysis was 0.544 (95% CI: 0.254, 0.744). Average CGM and MAGE values on dialysis day were not significantly different from those of off-dialysis day in diabetes patients (MDs: -0.40 mmol/L [95% CI: -1.06, 0.26]; P=0.23; and MAGE 0.50 mmol/L [95% CI: -0.01, 1.00]; P=0.05). Compared to pre-dialysis values, average CGM and MAGE values were significantly lower during dialysis in diabetes patients (MDs: -2.11 mmol/L [95% CI: -3.25, -0.97]; P=0.0003 and MAGE -2.24 mmol/L [95% CI: -3.99, -0.50]; P=0.01). CONCLUSIONS: CGM is an efficient method of glycemic monitoring in diabetes patients on dialysis. CGM had similar correlations with HbA1c and glycated albumin.