Evaluation of Glycemic Profiles in Diabetic Patients on Dialysis Under Insulin Balsal-bolus Protocol, Using Freestyle Libre
- Conditions
- Diabetic
- Registration Number
- NCT04288050
- Lead Sponsor
- University Hospital, Montpellier
- Brief Summary
In France, chronic end-stage renal disease affects more than 11,000 new patients each year who will require dialysis or renal transplantation, of whom approximately 22.6% of new cases are related to diabetes. Among them, about 94% are managed by hemodialysis (HD), the others by peritoneal dialysis (PD). In addition, nearly 42% of dialysis patients have diabetes. There are issues related to glycemic control during dialysis and specific to each dialysis technique. Thus, hypoglycemic risk is the main risk observed during hemodialysis sessions, linked in particular to the use of a 1g/L glucose free dialysate, a decrease in renal neoglucogenesis and alterations in metabolic pathways. In addition, long-term glycemic control is difficult to assess in dialysis patients, because of the limitations of HbA1c witch is frequently underestimated.
This can be explained by 2 mechanisms:
* EPO treatment is associated with an increase in the proportion of young érythrocytes
* reduction in the lifetime of red blood cells reducing the duration of interaction between glucose and hemoglobin.
The results of studies conducted using continuous glucose measurements over a short period of time (48 hours to 5 days) suggest a benefit in using continuous glucose measurement to detect glycemic fluctuations during dialysis. To our knowledge, no studies have been conducted to evaluate longer-term glycemic control with this technology. In addition, the investigators now have the Freestyle, which allows us to record the continuous measurement of interstitial glucose over a longer period of time and is reimbursed for people on insulin basal-bolus protocol.
Thus, the investigators propose an observational study to evaluate glycemic control during dialysis sessions, but also to analyze the correlation between parameters measured with Freestyle and HbA1c measured routinely, according to the follow-up recommendations in diabetics.
- Detailed Description
Data : patient data (clinical, biological and additional examinations) on a database registered at the University Hospital of Montpellier, on the secure server.
* Computerized medical records (DXcare) and consultation letters.
* Analysis of Freestyle data on a dedicated Freestyle View software, after downloading data on this software
Demographic characteristics: Age, gender Clinical history: Older diabetes, presence of diabetic retinopathy, diabetic maculopathy, microalbuminuria or proteinuria, older dialysis, type of dialysis, presence of ischemic heart disease, history of stroke, arteriopathy, gastroparesis, diabetic neuropathy, high blood pressure, hypercholesterolemia.
Treatments: diabetes, type of kidney replacement, other treatments
Biological assessment: Creatinemia, DFG, microalbuminuria, HbA1C, Hemoglobinemia, HDL, LDL, triglyceridemia, cholesterol, albuminuria/creatinuria ratio, proteinuria/creatinuria ratio
Patients will sign a non-opposition form.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 80
Not provided
Not provided
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Evaluate the time in range glycemic profile 12 month Evaluate the time in range glycemic profile in diabetic patients undergoing dialysis
- Secondary Outcome Measures
Name Time Method Time below range of glycemic target 6 month Time below range of glycemic target
Number of hypoglycemic events 6 month Number of hypoglycemic events
Evaluate the correlation between average interstitial glucose measured at Freestyle and measured HbA1c. 6 month Evaluate the correlation between average interstitial glucose measured at Freestyle and measured HbA1c.
Time above range of glycemic target 6 month Time above range of glycemic target
Glucose management Indicator 6 month Glucose management Indicator
mean number of scans on diabetic subjects in Dialysis. 6 month mean number of scans on diabetic subjects in Dialysis.
Evaluate the Delta between measured HbA1c and GMI. 6 month Evaluate the Delta between measured HbA1c and GMI.
Trial Locations
- Locations (1)
Uhmontpellier
🇫🇷Montpellier, France