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Perit Dial Int 27(Supplement_3): 14- 2007
© 2007 International Society for Peritoneal Dialysis
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Clinical Experience

Continuous Glycemic Monitoring System (CGMS) Utility in Diabetic Patients Undergoing Peritoneal Dialysis

P.C. Fortes, J.G. Mendes, F. Gevert, C. Aita, M.C. Riella and R. Pecoits-Filho

Pontificia Universidade Católica do Paraná, Curitiba, Parana, Brazil

Objective: Patients on peritoneal dialysis, particularly those utilizing glucose-based solutions, are exposed to a continuous load of glucose absorbed from the peritoneal cavity, which may cause difficulties in the metabolic control. The use of CGMS in the monitoring of diabetic patients undergoing peritoneal dialysis is not well established. The aim of this study was to analyze the utility of CGMS in detecting glycemic disorders in this population. Methods: 27 patients were recruited in the study, and 18 patients completed the 3-day examination using a Medtronic device. Only tests with at least 24 hours lecture were considered in the analysis, and most failures were due to catheter disconnection. Results: The mean age of the patients was 55 years, 8 patients were female, and 8 patients were on APD. The mean glycemic load was 182 g/day. The mean fasting glycemia was 212±133 mg/dL and the mean HbA1c was 12±4%. The CGMS provided an area above the higher limit of 49±42, a number of excursions above the higher limit of 6.3±3.6, and a duration above the higher limit of 55±30%. There were no differences in CGMS results when comparing patients divided according to their transport status. Although there were no significant differences in CGMS results between APD and CAPD, glycemic markers were significantly higher [fasting glycemia (p<0.01), fructosamine (p<0.001), and HbA1c (p=0.07)] in APD patients compared to CAPD. When only the night period was analyzed, 50% of the patients showed alterations (40% with hyperglycemia and 10% with hypoglycemia). We could not observe significant correlations between CGMS parameters and glycemic markers in this population. Conclusions: The glycemic control in this high-risk population is very poor, no matter what marker is utilized. APD patients appear to have worse glycemic control than CAPD patients. CGMS can provide useful data to improve glycemic control, particularly in the identification of nocturnal hyper- and hypoglycemia.






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