Real‐world use of continuous glucose monitoring in people with type 2 diabetes and chronic kidney disease or on dialysis

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INTRODUCTION: Continuous glucose monitoring (CGM) has become the standard of care for people with type 1 diabetes (T1D) and some people with type 2 diabetes (T2D). However, there is a lack of data regarding CGM use in people with T2D and chronic kidney disease (CKD), who are at increased risk of hypoglycaemia. We assess the use of CGM and glucose outcomes in this cohort. METHODS: Retrospective, observational analysis of adults on CGM attending a tertiary diabetes renal clinic between January 2023 and September 2024. People with T2D on multiple daily insulin injections (defined as 2 or more insulin injections per day) and CKD stage 3-5 (eGFR <60, on renal replacement therapy or post-renal transplant) were included. HbA1c was assessed pre- and post-initiation of CGM. CGM metrics were analysed for percentage times in ranges and other glycaemic metrics. RESULTS: A total of 177 adults (median (interquartile range)) aged 64.0 (56.0-71.0) years were included. Time below range (<3.9 mmol/L) was significantly reduced (median (interquartile range)) from 1.0 (0.0-2.0)% to 0.0 (0.0-1.0)% following CGM initiation (p = 0.007). Hypoglycaemia leading to an insulin dose reduction was revealed by CGM in 91/177 participants (51.4%). Median HbA1c pre- and post-CGM was 64.0 (53.0-79.0) mmol/mol (8.0, 7.0-9.4%) and 62.0 (51.8-73.0) mmol/mol (7.8, 6.9-8.8%), respectively (p < 0.001). HbA1c reduction was observed in 114/177 participants (64.4%). CONCLUSION: CGM use was associated with the identification of hypoglycaemia and improvements in HbA1c in people with T2D and CKD. These real-world data demonstrate the importance of CGM technology to high-risk individuals with diabetes and CKD.

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