Real-Time Continuous Glucose Monitoring Among People With Type 2 Diabetes and End-Stage Kidney Failure Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial

OBJECTIVE: There is a need for improved glycemia monitoring tools for people with type 2 diabetes (T2D) and end-stage kidney failure (ESKF). RESEARCH DESIGN AND METHODS: This prospective, randomized, crossover trial compared the efficacy of real-time continuous glucose monitoring (rtCGM) with capillary blood glucose (CBG) testing in adults with T2D and ESKF undergoing hemodialysis. The primary outcome was percentage of time below range (%TBR) <70 mg/dL. RESULTS: The %TBR <70 mg/dL was not significantly different between groups (mean 1.17% ± 1.8 vs. 1.29% ± 2.7; P = 0.28). Compared with CBG testing, percentage time in range (%TIR) was higher (63.4% ± 24 vs. 54.5% ± 23) and mean glucose lower (173.6 ± 37 vs. 187.7 ± 38 mg/dL) after the rtCGM intervention, while percentage time above range (%TAR) >180 mg/dL (35.3% ± 25 vs. 44.3% ± 23) and >250 mg/dL decreased (12.3% ± 15 vs. 18.8% ± 19) (all P ≤ 0.01). CONCLUSIONS: In adults with T2D and ESKF undergoing hemodialysis, TBR was minimal and not influenced by rtCGM use. Compared with CBG testing, %TIR and %TAR improved during the rtCGM intervention. Future studies are needed to confirm the benefits of rtCGM in this population.