Scoping Review-Diabetes Technology for Individuals on Kidney Replacement Therapy (Dialysis): Current Trends and Future Directions.

Abstract

Aim: This review aims to map the existing literature on the use of diabetes technology in people receiving dialysis, with a focus on utilization, accuracy, and effectiveness.

Methods: A scoping review was conducted using the Joanna Briggs Institute methodology, with systematic searches of Medline, Embase, and CINAHL for studies on diabetes technologies in dialysis populations.

Results: The search identified 1060 continuous glucose monitoring (CGM) and 1467 continuous subcutaneous insulin infusion or automated insulin delivery (CSII/AID) records, with 64 studies included. Eighteen studies assessed CGM accuracy, reporting mean absolute relative difference (MARD) values ranging from 8.1% to 29%, with over 97% of readings falling within Clarke error grid zones A or B. Thirteen studies compared glycemic markers, finding that HbA_1c underestimated glucose by 7.3 mmol/mol, while glycated albumin showed a stronger correlation (r = 0.508). Four studies reported on dialysis effects, showing that people on automated peritoneal dialysis (APD) had lower mean glucose levels (181 ± 64 mg/dL) compared to continuous ambulatory peritoneal dialysis (CAPD) (238 ± 67 mg/dL; P < .05). Eleven studies evaluating diabetes treatment efficacy using CGM found that dulaglutide significantly reduced glucose CV from 28.1% to 19.8% (P = .003). Twenty-two studies examining glycemic outcomes reported that TIR was lower on dialysis days (80.2%, P = .02). Finally, four AID studies reported TIR improvements of up to 37.6% and a 1.5 mmol/L reduction in glucose (P = .003).

Conclusion: This review highlights the potential of CGM and AID to improve diabetes outcomes in people on dialysis. While their clinical utility is evident, broader access and further research are needed to optimize their use in this high-risk population.