Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico

Abstract

The diabetic nephropathy is considered the main cause of end-stage renal disease. Glycemic control in dialysis patients presents difficulties because both uremia and dialysis affect tissue secretion and insulin sensitivity. Studies highlight the inaccuracy of glycated hemoglobin (HbA1c), and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, Libre Flash is the most used in daily practice in Brazil in 2021, but still lacks consensus on its use in dialysis. The objective was to compare blood glucose measurements by capillary measurement to those by interstitial measurement in diabetic dialysis patients. A prospective randomized study of 3 weeks was carried out with 12 patients for digital glycemic monitoring alone and 12 for digital puncture associated with an interstitial measurement sensor. The glycemic results were compared using the body mass index (BMI), the intradialytic fluid loss and the hemoglobin values of the patients as a comparison parameter. Analyzing the capillary and interstitial measurements in the same patient, similar values were observed in the capillary and interstitial measurements at the beginning of dialysis in the first seven days (184.1 ± 69.5mg/dl and 173.1 ± 78.9mg/dl respectively, p=0.303 ), similar as well in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2mg/dl and 201.3 ± 77.0mg/dl respectively, p=0.466), in dialysis water loss less than 2 liters (185.5 ± 82.6mg/dl and 183.1 ± 94.0mg/dl respectively and p=0.805) and in hemoglobin greater than 12g/dl (152.0 ± 35.5mg/dl and 129.5 ± 47.4mg/dl respectively, p=0.016). In the correlation of the capillary measure with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0 %, 10.4% and 0.0% respectively and in the Parkes Error Grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. When comparing the groups, there was no difference in the initial (200.7 ± 96.4mg/dl and 209.4 ± 66.6mg/dl, respectively) and final (200.5 ± 78.6mg/dl and 204) plasma glucose levels, 5 ± 65.2mg/dl respectively). In conclusion the interstitial blood glucose measurement system is flawed, but clinical decision-making based on measured values can be done with a good safety margin.