In response to the comment by Riveline and Hadjadj (1) on the work presented in our article “Assessing Glycemic Control in Maintenance Hemodialysis Patients With Type 2 Diabetes” (2), we would like to acknowledge the following:
1) Due to the abundance of existing evidence on the accuracy of continuous glucose monitoring (CGM) in patients with diabetes and the lack of interference from urea metabolites with the GlucoDay (data provided by manufacturer), we did not set out to prove the accuracy of CGM in hemodialyzed patients. It is reassuring to see the accuracy of CGM confirmed by the authors in their study (3).
2) We have reviewed the glucose concentrations in the dialysate fluids used for the study population and have identified that the following correction must be made regarding these concentrations: most patients were using a dialysate solution with 2 g/l glucose (not 2 mmol/l as stated in the article), which translates to 200 mg/dl or 11.1 mmol/l, while a smaller number were using a dialysate solution with 1 g/l glucose, which is equivalent to 100 mg/dl or 5.5 mmol/l (the same as that used for the study by Riveline et al. [3]). However, this does not change the fact that we did observe postdialysis hypoglycemic episodes, and of the three patients who had profound hypoglycemia (<2.5 mmol/l), two were on the dialysate fluid with 2 g/l glucose. We agree with the authors that relative hypoglycemia is a dangerous side effect that must be prevented in this at-risk population. To this end, we would like to highlight that providers of dialysate solutions in the U.K. are looking to standardize the glucose concentration for all dialysates at 1 g/l (equivalent to 5.5 mmol/l), while the evidence from our study shows that that may not be high enough to prevent postdialysis asymptomatic hypoglycemia.
In conclusion, we would like to thank the authors for their insight and helpful comments and further emphasize the importance of closely monitoring glycemic control in hemodialyzed patients with diabetes.
Acknowledgments
No potential conflicts of interest relevant to this article were reported.