1013-P: Evaluation of a Continuous Glucose Monitor in Patients with Diabetes on Hemodialysis

Diabetes management is critical for patients with end-stage renal disease (ESRD). Patients with ESRD experience impaired glucose metabolism, necessitating continuous monitoring. Continuous Glucose Monitors (CGMs) are an effective instrument to monitor glucose levels. The Flash Glucose Monitor (FGM), a CGM variation, displays live, on-demand glucose data; however, the accuracy of FGMs on patients with diabetes on hemodialysis in Canada is not well supported. This study investigates the accuracy of the Freestyle Libre 2, an FGM, in patients with diabetes on hemodialysis at the Windsor Regional Hospital in Windsor, Ontario. A prospective cohort study was performed. Participants ≥ 18 years of age with type 1 or 2 diabetes undergoing hemodialysis were invited to participate. Over 14 days, blood glucose was collected using a capillary blood glucose monitor (CBGM) and FGM four times daily. Accuracy of FGM was assessed via Mean Absolute Relative Difference (MARD), while a Clarke Error Grid correlated paired results between FGM and CBGM. Among 398 paired readings from 8 participants, mean age was 56.8 +/- 4.9 years, 62.5% were male, mean A1C was 7.7 +/- 2.2%, and 25% and 75% had type 1 and type 2 diabetes, respectively. The MARD between the FGM and CBGM was 10.5 ± 8.9%, with 83% of FGM values within ± 1.5 mmol/L of CBGM values. Clarke Error Grid analysis showed 94.5%, 5.5%, 0%, and 0% of correlated pairs in zone A, zone B, zone C, zone D, and zone E respectively, indicating 100% of values within the clinically safe range. Results support the clinical use of Freestyle Libre 2 in patients with diabetes on hemodialysis. With accurate monitoring using FGMs, physicians can better manage hypoglycemia and hyperglycemia associated with hemodialysis, thereby improving patient outcomes. Future work should aim to increase sample size, compare sensor accuracy in patients with diabetes without hemodialysis, and those on peritoneal dialysis.