Background: Type 2 diabetes (T2D) patients with chronic kidney disease (CKD) are at high risk of hypoglycemia due to decreased renal gluconeogenesis and clearance of diabetes medications. This study aims to quantify the burden of hypoglycemia in this population, and identify potential risk factors.
Methods: Outpatient T2D subjects with CKD (eGFR <60ml/min per 1.73m2) were recruited to wear a Freestyle Libre-Pro sensor for 2 weeks. Collected data was analyzed for low interstitial fluid glucose (IFG) burden. IFG values of less than 72mg/dL and 50mg/dL that persisted for at least 15 minutes were defined as ‘low sensor glucose (LSG) ’ and ‘very low sensor glucose (VLSG) ’ respectively. Occurrence of VLSG events were correlated with patient-reported symptoms. Univariate analysis with Poisson regression was performed to look for predictive factors for LSG and VLSG events.
Results: A total of 77 subjects with CKD were included in the study, 46 (59.7%) male and 31 (40.3%) female. The subjects were 67.9 ± 8.9 years old with duration of diabetes of 22.0 ± 12.1 years and HbA1c of 8.1 ± 1.9%. The subjects wore the sensor for 14.3 ± 1.6 days. Sixty-five subjects (84.4%) experienced a total of 612 LSG events (mean number of events per subject 8.0 ± 8.6) with total duration of 1834 ± 2812 minutes while 44 subjects (57.1%) experienced a total of 244 VLSG events (mean number of events per subject 5.6 ± 5.9) with total duration of 1080 ± 1838 minutes. Majority of subjects who experienced VLSG events (90.9%) did not report associated symptoms. Lower HbA1c and lower mean glucose were associated with LSG (rate ratio of 0.79 (0.70 - 0.89) and 0.71 (0.66 - 0.76) respectively with p values <0.05) . Similar results were found for VLSG events. Interestingly, the degree of renal impairment did not predict for LSG or VLSG events.
Conclusion: Clinicians must consider what appropriate glycemic targets should be for T2D patients with CKD as this modifiable risk factor is highly predictive of hypoglycemic events.
K.Tian: None. L.C.Ang: None. S.Goh: Advisory Panel; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Sanofi. Y.Bee: None. J.Choo: Advisory Panel; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, GlaxoSmithKline plc., Novartis AG, Consultant; AstraZeneca, Nitto Denko Asia Technical Centre, Novartis AG, Research Support; AstraZeneca, Nitto Denko Asia Technical Centre, Speaker's Bureau; Abbott, Bayer AG. M.M.Teh: None.