Continuous Glucose Monitoring to Optimize Management of Diabetes in Patients with Advanced CKD

What is it about?

Treatment of patients with diabetes and CKD includes optimizing glycemic control using lifestyle modifications and drugs that safely control glycemia and improve clinical kidney and cardiovascular disease outcomes. However, patients with advanced CKD, defined as eGFR <30 mL/min/1.73m2 or kidney disease treated with dialysis, have limitations to use of some preferred glucose-lowering medications, are often treated with insulin, and experience high rates of severe hypoglycemia. Moreover, HbA1c accuracy decreases as GFR deteriorates. Hence, there is a need for better glycemic monitoring tools. Continuous glucose monitoring (CGM) allows 24-hour glycemic monitoring to understand patterns and the impact of lifestyle and medications. Real-time CGM can be used to guide administration of insulin and non-insulin therapies. CGM can overcome the limitations of self-monitored capillary glucose testing and HbA1c and has been shown to prevent hypoglycemic excursions in some populations. More data are needed to understand whether similar benefits can be obtained for patients with diabetes and advanced CKD. This review provides an updated approach to management of glycemia in advanced CKD, focusing on the role of CGM in this high-risk population.

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