Diurnal variations of blood glucose by continuous blood glucose monitoring in peritoneal dialysis patients with diabetes.

Abstract

Exaggerated postprandial increase in blood glucose has been postulated to be associated with cardiovascular injury. The concentration of blood glucose is altered by glucose absorption from peritoneal dialysis (PD) fluids. In PD patients, we used continuous blood glucose monitoring (CGM) to analyze diurnal variations in blood glucose. Diurnal blood glucose was determined in 10 diabetic PD patients who used CGM (iPro2: Medtronic, Northridge, CA, U.S.A.) for 3 days. Blood glucose concentrations before and after glycemic control were monitored in 5 patients. Correlations between CGM parameters [standard deviation of blood glucose (SDG)], peritoneal function [dialysate-to-plasma ratio of creatinine (D/P Cr) and end-to-initial dialysate (D/D0) glucose], 24-hour peritoneal glucose absorption, and glycemic index were determined. In 5 patients, CGM was performed again after adjustments to antidiabetic drugs. A large diurnal variation, especially at night, was observed in this patient cohort. No correlation of HbA1c with mean blood glucose concentration was observed. Although SDG had no association with 24-hour peritoneal glucose absorption, it did show an association with D/P Cr and D/D0 glucose. The SDG was significantly lower after treatment with a dipeptidyl peptidase IV inhibitor or an increase in insulin dose. Results of the present study indicate that diurnal variations in glucose depend on the speed of peritoneal glucose absorption rather than the net glucose absorption.