Impact of visceral adiposity on glycemic variability in patients with insulin-treated type 2 diabetes undergoing hemodialysis

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BACKGROUND Glycemic variability (GV) is increasingly recognized as a major metabolic risk in patients with type 2 diabetes (T2D) undergoing hemodialysis (HD); however, key contributors remain unclear. AIM To identify clinical predictors of GV – measured by differences in time in range (ΔTIR) – between HD and off-HD days in patients with insulin-treated T2D. METHODS In this prospective study, 35 patients with insulin-treated T2D on online HD were monitored using continuous glucose monitoring over 20 days. Glucometric variables included mean glucose, TIR, and glucose management indicator. Patients were stratified by ΔTIR into low (< 5%) or high (> 5%) fluctuation groups. Body composition was assessed using multifrequency bioelectrical impedance analysis, including visceral fat area (VFA), skeletal muscle index, and extracellular-to-total body water ratio. RESULTS Patients with ΔTIR > 5% showed higher glucose levels (HD: 187.1 ± 44.3 mg/dL; off-HD: 201.9 ± 52.3 mg/dL), reduced TIR, elevated glucose management indicator (8.02% ± 1.14%), and significantly lower VFA (63.4 ± 42.7 cm2 vs 127.0 ± 49.5 cm2; P = 0.001). Skeletal muscle index and hydration parameters were not different. VFA independently predicted ΔTIR > 5% (odds ratio = 0.077; P = 0.016), and a VFA threshold of approximately 63 cm² yielded 88% sensitivity and 67% specificity (area under the curve of 0.812; P = 0.003). CONCLUSION VFA is a strong independent marker of GV in patients with insulin-treated T2D on HD, supporting body composition profiling in this population.

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