Continuous glucose dynamics monitoring in diabetic patients with peritoneal dialysis

Abstract

Background : Glucose dynamics in patients on peritoneal dialysis (PD) is influenced by many factors.

Objectives : We evaluated the dynamics of interstitial fluid (ISF) glucose in diabetic patients undergoing PD, controlled for caloric food intake, daily activities, and hypoglycemic agents.

Methods : We studied all type-2 diabetic patients at the PD clinic of King Chulalongkorn Memorial Hospital between 2007 and 2008. They received 1.5% or 4.25% glucose during continuous ambulatory peritoneal dialysis (CAPD 1.5% or 4.25%), or 1.5% glucose continuous cycling peritoneal dialysis (CCPD 1.5%). Continuous glucose monitoring system and finger-stick were used to assess ISF and blood glucose levels for 72 hours, respectively. Sixteen patients (9 CAPD and 7 CCPD) were assessed.

Results : Median age, diabetes onset, and years on PD were 71, 17, and 1.5 years, respectively. There was strong correlation between ISF and blood glucose level (r = 0.937). The mean ISF glucose levels between dialysate and non-dialysate days were not significantly different (P = 0.08) in spite of higher total caloric intake on dialysate day (P = 0.049). However, in the CAPD 4.25% group, mean ISF glucose and total consumed calories were significantly higher on dialysate than non-dialysate day (P = 0.026 and 0.031, respectively). The difference disappeared after adjustment for food calories. ISF glucose started rising after a 15-minute infusion of dialysate then sustained till 4 hours with a mean increase of 55%.

Conclusions : The evidence suggested that high-glucose peritoneal dialysate can increase ISF glucose but the effect is confounded by food caloric intake.