OBJECTIVE In the general population, continuous glucose monitoring (CGM) provides convenient and less-invasive glucose measurements than conventional self-monitored blood glucose and results in reduced hypo-/hyperglycemia and increased time-in-target glucose range. However, accuracy of CGM versus blood glucose is not well established in hemodialysis patients. RESEARCH DESIGN AND METHODS Among 31 maintenance hemodialysis patients with diabetes hospitalized from October 2020–May 2021, we conducted protocolized glucose measurements using Dexcom G6 CGM versus blood glucose, with the latter measured before each meal and at night, plus every 30-min during hemodialysis. We examined CGM-blood glucose correlations and agreement between CGM versus blood glucose using Bland-Altman plots, percentage of agreement, mean and median absolute relative differences (ARDs), and consensus error grids. RESULTS Pearson and Spearman correlations for averaged CGM versus blood glucose levels were 0.84 and 0.79, respectively; Bland-Altman showed the mean difference between CGM and blood glucose was ∼+15 mg/dL. Agreement rates using %20/20 criteria were 48.7%, 47.2%, and 50.2% during the overall, hemodialysis, and nonhemodialysis periods, respectively. Mean ARD (MARD) was ∼20% across all time periods; median ARD was 19.4% during the overall period and was slightly lower during nonhemodialysis (18.2%) versus hemodialysis periods (22.0%). Consensus error grids showed nearly all CGM values were in clinically acceptable zones A (no harm) and B (unlikely to cause significant harm). CONCLUSIONS In hemodialysis patients with diabetes, although MARD values were higher than traditional optimal analytic performance thresholds, error grids showed nearly all CGM values were in clinically acceptable zones. Further studies are needed to determine whether CGM improves outcomes in hemodialysis patients.

中文翻译：

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糖尿病血液透析患者连续血糖监测的准确性


目的 在普通人群中，与传统的自我监测血糖相比，连续血糖监测 （CGM） 提供了方便且侵入性更小的血糖测量，并导致低/高血糖减少和目标血糖范围时间增加。然而，在血液透析患者中，CGM 与血糖的准确性尚未得到充分证实。研究设计和方法 在 2020 年 10 月至 2021 年 5 月住院的 31 名维持性血液透析糖尿病患者中，我们使用 Dexcom G6 CGM 与血糖进行了协议化葡萄糖测量，后者在每餐前和晚上测量，加上血液透析期间每 30 分钟测量一次。我们使用 Bland-Altman 图、一致性百分比、平均值和中位数绝对相对差异 （ARD） 以及共识误差网格检查 CGM-血糖相关性和 CGM 与血糖之间的一致性。结果 平均 CGM 与血糖水平的 Pearson 和 Spearman 相关性分别为 0.84 和 0.79;Bland-Altman 显示 CGM 和血糖之间的平均差异为 ∼+15 mg/dL。在总体、血液透析和非血液透析期间，使用 %20/20 标准的一致性分别为 48.7% 、 47.2% 和 50.2%。所有时间段的平均 ARD （MARD） 约为 20%;整个期间的中位 ARD 为 19.4%，非血液透析期间 （18.2%） 略低于血液透析期间 （22.0%）。共识误差网格显示，几乎所有 CGM 值都在临床可接受的区域 A （无伤害） 和 B 区域 （不太可能造成重大伤害）。结论 在糖尿病血液透析患者中，尽管 MARD 值高于传统的最佳分析性能阈值，但误差网格显示几乎所有 CGM 值都在临床可接受的区域。 需要进一步的研究来确定 CGM 是否能改善血液透析患者的预后。