Контроль гликемии у пациентов с сахарным диабетом на программном гемодиализе
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Lobanova K.G., Severina A.S., Martinov S.A., et al. Glycemic control in patients with diabetes mellitus on hemodialysis. Therapeutic Archive. 2019; 91 (10): 124–134. DOI: 10.26442/00403660.2019.10.000352
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Ключевые слова: терминальная почечная недостаточность, хроническая болезнь почек, гемодиализ, сахарный диабет, гипогликемия, гликированный гемоглобин, гликированный альбумин, фруктозамин, инсулинотерапия, инсулин, суточное мониторирование гликемии.
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Achievement of stabilization of carbohydrate metabolism in patients with diabetes mellitus, receiving renal replacement therapy with hemodialysis, is a significant problem in endocrinology. It has to do with multiple factors of this cohort of patients, which affect the level of glycemia, pharmacokinetic of drugs, the efficiency of glycemic control. At the moment, the most efficiency method of glycemic control in patients with type 2 diabetes mellitus on hemodialysis is insulin therapy in the basis-bolus regime by analogues of human insulin. The use of oral hypoglycemic agents is significantly limited. The hemoglobin A1c (HbA1c) remains the main parameter of glycemic control. The simultaneous use of continuous glucose monitoring allows to reveal the true level of glucose of the blood and to carry out the timely correction of therapy in order to achieve targets for glycemic control and to decrease the risk of hypoglycemic episodes. At the moment other glycemic control markers such as glycated albumin and fructosamine are described. However, in routine practice at the moment these indicators are not used due to the lack of sufficient evidentiary base of their use in this cohort of patients.
Keywords: terminal renal failure, chronic kidney disease, hemodialysis, diabetes mellitus, hypoglycemia, glycated hemoglobin, glycated albumin, fructosamine, insulin, insulin therapy, continuous glucose monitoring.
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6. Sudha MJ, Salam HS, Viveka S, et al. Assessment of changes in insulin requirement in patients of type 2 diabetes mellitus on maintenance hemodialysis. J Nat Sci Biol Med. 2017;8(1):64-8. doi: 10.4103/0976-9668.198348
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14. Park J, Lertdumrongluk P, Molnar MZ, et al. Glycemic control in diabetic dialysis patients and the burnt-out diabetes phenomenon. Curr Diab Rep. 2012;12(4):432-9. doi: 10.1007/s11892-012-0286-3
15. Ricks J, Molnar MZ, Kovesdy CP, et al. Glycemic control and cardiovascular mortality in hemodialysis patients with diabetes: a 6-year cohort study. Diabetes. 2012;61(3):708-15. doi: 10.2337/db11-1015
16. Abe M, Hamano T, Hoshino J, et al. Is there a "burnt-out diabetes" phenomenon in patients on hemodialysis? Diabetes Res Clin Pract. 2017;130:211-20. doi: 10.1016/j.diabres.2017.06.012
17. Hoshino J, Larkina M, Karaboyas A, et al. Unique hemoglobin A1c level distribution and its relationship with mortality in diabetic hemodialysis patients. Kidney Int. 2017;92(2):497-503. doi: 10.1016/j.kint.2017.02.008
18. Ramirez SP, McCullough KP, Thumma JR, et al. Hemoglobin A(1c) levels and mortality in the diabetic hemodialysis population: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Diabetes Care. 2012;35(12):2527-32. doi: 10.2337/dc12-0573
19. Yoo DE, Park JT, Oh HJ, et al. Good glycemic control is associated with better survival in diabetic patients on peritoneal dialysis: a prospective observational study. PLoS One. 2012;7(1):e30072. doi: 10.1371/journal.pone.0030072
20. Kim Y, Park JC, Molnar MZ, et al. Correlates of low hemoglobin A1c in maintenance hemodialysis patients. Int Urol Nephrol. 2013;45(4):1079-90. doi: 10.1007/s11255-012-0208-y
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27. Okada T, Nakao T, Matsumoto H, et al. Association between markers of glycemic control, cardiovascular complications and survival in type 2 diabetic patients with end-stage renal disease. Intern Med. 2007;46:807-14.
28. Fukuoka K, Nakao K, Morimoto H, et al. Glycated albumin levels predict long-term survival in diabetic patients undergoing haemodialysis. Nephrology (Carlton). 2008;13:278-83. doi: 10.1111/j.1440-1797.2007.00864.x
29. Klonoffa DC, Ahnb D, Drincicc A. Continuous glucose monitoring: A review of the technology and clinical use. Diabetes Res Clin Pract. 2017;133:178-92. doi: 10.1016/j.diabres.2017.08.005
30. Gai M, Merlo I, Dellepiane S, et al. Glycemic pattern in diabetic patients on hemodialysis: continuous glucose monitoring (CGM) analysis. Blood Purif. 2014;38(1):68-73. doi: 10.1159/000362863
31. Képénékian L, Smagala A, Meyer L, et al. Continuous glucose monitoring in hemodialyzed patients with type 2 diabetes: a multicenter pilot study. Clin Nephrol. 2014;82(4):240-6. doi: 10.5414/CN108280
32. Joubert M, Fourmy C, Henri P, et al. Effectiveness of continuous glucose monitoring in dialysis patients with diabetes: the DIALYDIAB pilot study. Diabetes Res Clin Pract. 2015;107(3):348-54. doi: 10.1016/j.diabres.2015.01.026
33. Ólafsdóttir AF, Polonsky W, Bolinder J, et al. A Randomized Clinical Trial of the Effect of Continuous Glucose Monitoring on Nocturnal Hypoglycemia, Daytime Hypoglycemia, Glycemic Variability, and Hypoglycemia Confidence in Persons with Type 1 Diabetes Treated with Multiple Daily Insulin Injections (GOLD-3). Diabetes Technol Ther. 2018;20(4):274-84. doi: 10.1089/dia.2017.0363
34. Mirani M, Berra C, Finazzi S, et al. Inter-day glycemic variability assessed by continuous glucose monitoring in insulin-treated type 2 diabetes patients on hemodialysis. Diabetes Technol Ther. 2010;12(10):749-53. doi: 10.1089/dia.2010.0052
35. Heinemann L, Freckmann G, Ehrmann D, et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet. 2018;391(10128):1367-77. doi: 10.1016/S0140-6736(18)30297-6
36. Marbury TC, Ruckle JL, Hatorp V, et al. Pharmacokinetics of repaglinide in subjects with renal impairment. Clin Pharmacol Ther. 2000;67(1):7-15. doi: 10.1067/mcp.2000.103973
37. Hasslacher C; Multinational Repaglinide Renal Study Group. Safety and efficacy of repaglinide in type 2 diabetic patients with and without impaired renal function. Diabetes Care. 2003;26(3):886-91.
38. Terawaki Y, Nomiyama T, Akehi Y, et al. The efficacy of incretin therapy in patients with type 2 diabetes undergoing hemodialysis. Diabetol Metab Syndr. 2013;5(1):10. doi: 10.1186/1758-5996-5-10
39. Osonoi T, Saito M, Tamasawa A, et al. Effect of hemodialysis on plasma glucose profile and plasma level of liraglutide in patients with type 2 diabetes mellitus and end-stage renal disease: a pilot study. PLoS One. 2014;9(12):e113468. doi: 10.1371/journal.pone.0113468
40. Idorn T, Knop FK, Jørgensen MB, et al. Safety and Efficacy of Liraglutide in Patients With Type 2 Diabetes and End-Stage Renal Disease: An Investigator-Initiated, Placebo-Controlled, Double-Blind, Parallel-Group, Randomized Trial. Diabetes Care. 2016;39(2):206-13. doi: 10.2337/dc15-1025
41. Park SH, Nam JY, Han E, et al. Efficacy of different dipeptidyl peptidase-4 (DPP-4) inhibitors on metabolic parameters in patients with type 2 diabetes undergoing dialysis. Medicine (Baltimore). 2016;95(32):e4543. doi: 10.1097/MD.0000000000004543
42. Nakamura Y, Hasegawa H, Tsuji M, et al. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors. World J Diabetes. 2015;6(6):840-9. doi: 10.4239/wjd.v6.i6.840
43. Padmanabhan A, Velayudham B, Vijaykumar N, et al. Evaluation of glycemic status during the days of hemodialysis using dialysis solutions with and without glucose. Saudi J Kidney Dis Transpl. 2018;29(5):1021-7. doi: 10.4103/1319-2442.243951
44. Burmeister JE, Miltersteiner Dda R, Burmeister BO, et al. Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia. Arch Endocrinol Metab. 2015;59(2):137-40. doi: 10.1590/2359-3997000000026
45. Burmeister JE, Scapini A, da Rosa Miltersteiner D, et al. Glucose-added dialysis fluid prevents asymptomatic hypoglycaemia in regular haemodialysis. Nephrol Dial Transplant. 2007;22(4):1184-9. doi: 10.1093/ndt/gfl710
46. Raimann JG, Kruse A, Thijssen S, et al. Metabolic effects of dialyzate glucose in chronic hemodialysis: results from a prospective, randomized crossover trial. Nephrol Dial Transplant. 2012;27(4):1559-68. doi: 10.1093/ndt/gfr520
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3. [Dedov II, ed. Dialysis therapy in patients with diabetes mellitus. Moscow: Ministry of health and social development of the Russian Federation, 2009 (In Russ.)].
4. Abe M, Kalantar-Zadeh K. Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nat Rev Nephrol. 2015;11(5):302-13. doi: 10.1038/nrneph.2015.38
5. Wakino S, Minakuchi H, Miya K, et al. Aldosterone and Insulin Resistance: Vicious Combination in Patients on Maintenance Hemodialysis. Ther Apher Dial. 2018;22(2):142-51. doi: 10.1111/1744-9987.12632
6. Sudha MJ, Salam HS, Viveka S, et al. Assessment of changes in insulin requirement in patients of type 2 diabetes mellitus on maintenance hemodialysis. J Nat Sci Biol Med. 2017;8(1):64-8. doi: 10.4103/0976-9668.198348
7. Sobngwi E, Enoru S, Ashuntantang G, et al. Day-to-day variation of insulin requirements of patients with type 2 diabetes and end-stage renal disease undergoing maintenance hemodialysis. Diabetes Care. 2010;33(7):1409-12. doi: 10.2337/dc09-2176
8. Nakao T, Inaba M, Abe M, et al. Best practice for diabetic patients on hemodialysis 2012. Ther Apher Dial. 2015;19 Suppl 1:40-66. doi: 10.1111/1744-9987.12299
9. Guthoff M, Wagner R, Vosseler D, et al. Impact of end-stage renal disease on glucose metabolism – a matched cohort analysis. Nephrol Dial Transplant. 2017;32(4):670-6. doi: 10.1093/ndt/gfx018
10. Rhee CM, Leung AM, Kovesdy CP, et al. Updates on the management of diabetes in dialysis patients. Semin Dial. 2014;27(2):135-45. doi: 10.1111/sdi.12198
11. Tzamaloukas AH. Interpreting glycosylated hemoglobin in diabetic patients on peritoneal dialysis. Adv Peritoneal Dial. 1996;12:171-5.
12. Sinha N, Mishra TK, Singh T, Gupta N. Effect of iron deficiency anemia on hemoglobin A1 levels. Ann Lab Med. 2012;32:17-22.
13. Sharif A, Baboola K. Diagnostic application of the A1 assay in renal disease. J Am Soc Nephrol. 2010;21:383-94.
14. Park J, Lertdumrongluk P, Molnar MZ, et al. Glycemic control in diabetic dialysis patients and the burnt-out diabetes phenomenon. Curr Diab Rep. 2012;12(4):432-9. doi: 10.1007/s11892-012-0286-3
15. Ricks J, Molnar MZ, Kovesdy CP, et al. Glycemic control and cardiovascular mortality in hemodialysis patients with diabetes: a 6-year cohort study. Diabetes. 2012;61(3):708-15. doi: 10.2337/db11-1015
16. Abe M, Hamano T, Hoshino J, et al. Is there a "burnt-out diabetes" phenomenon in patients on hemodialysis? Diabetes Res Clin Pract. 2017;130:211-20. doi: 10.1016/j.diabres.2017.06.012
17. Hoshino J, Larkina M, Karaboyas A, et al. Unique hemoglobin A1c level distribution and its relationship with mortality in diabetic hemodialysis patients. Kidney Int. 2017;92(2):497-503. doi: 10.1016/j.kint.2017.02.008
18. Ramirez SP, McCullough KP, Thumma JR, et al. Hemoglobin A(1c) levels and mortality in the diabetic hemodialysis population: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Diabetes Care. 2012;35(12):2527-32. doi: 10.2337/dc12-0573
19. Yoo DE, Park JT, Oh HJ, et al. Good glycemic control is associated with better survival in diabetic patients on peritoneal dialysis: a prospective observational study. PLoS One. 2012;7(1):e30072. doi: 10.1371/journal.pone.0030072
20. Kim Y, Park JC, Molnar MZ, et al. Correlates of low hemoglobin A1c in maintenance hemodialysis patients. Int Urol Nephrol. 2013;45(4):1079-90. doi: 10.1007/s11255-012-0208-y
21. Bedi R, Dr Chowdhury TA, El-Sherbini N, et al. JBDS-IP Management of adults with diabetes on the haemodialysis unit. 2016 Apr. Brit J Diabetes. 2016 Apr.;16(2):69-77.
22. American Diabetes Association. Standarts of Medical Care in Diabetes – 2018. Diabetes Care. 2018:41(S.1). doi: 10.2337/dc18-Sint01
23. [Dedov II, Shestakova MV, Mayorov AYu, eds. Standards of specialized diabetes care. Moscow: Ministry of health and social development of the Russian Federation, 2017 (In Russ.)].
24. [Novitcki VV, Goldberg ED, et al. Pathophysiology. Moscow: GEOTAR-Media, 2009. Vol. 1. 848 p. (In Russ.)].
25. [Andrushkevich VV. Biochemical blood parameters, their reference values, causes of changes in serum levels. Novosibirsk, 2006. 29 p. (In Russ.)].
26. Shafi T, Sozio SM, Plantinga LC, et al. Serum fructosamine and glycated albumin and risk of mortality and clinical outcomes in hemodialysis patients. Diabetes Care. 2013;36(6):1522-33. doi: 10.2337/dc12-1896
27. Okada T, Nakao T, Matsumoto H, et al. Association between markers of glycemic control, cardiovascular complications and survival in type 2 diabetic patients with end-stage renal disease. Intern Med. 2007;46:807-14.
28. Fukuoka K, Nakao K, Morimoto H, et al. Glycated albumin levels predict long-term survival in diabetic patients undergoing haemodialysis. Nephrology (Carlton). 2008;13:278-83. doi: 10.1111/j.1440-1797.2007.00864.x
29. Klonoffa DC, Ahnb D, Drincicc A. Continuous glucose monitoring: A review of the technology and clinical use. Diabetes Res Clin Pract. 2017;133:178-92. doi: 10.1016/j.diabres.2017.08.005
30. Gai M, Merlo I, Dellepiane S, et al. Glycemic pattern in diabetic patients on hemodialysis: continuous glucose monitoring (CGM) analysis. Blood Purif. 2014;38(1):68-73. doi: 10.1159/000362863
31. Képénékian L, Smagala A, Meyer L, et al. Continuous glucose monitoring in hemodialyzed patients with type 2 diabetes: a multicenter pilot study. Clin Nephrol. 2014;82(4):240-6. doi: 10.5414/CN108280
32. Joubert M, Fourmy C, Henri P, et al. Effectiveness of continuous glucose monitoring in dialysis patients with diabetes: the DIALYDIAB pilot study. Diabetes Res Clin Pract. 2015;107(3):348-54. doi: 10.1016/j.diabres.2015.01.026
33. Ólafsdóttir AF, Polonsky W, Bolinder J, et al. A Randomized Clinical Trial of the Effect of Continuous Glucose Monitoring on Nocturnal Hypoglycemia, Daytime Hypoglycemia, Glycemic Variability, and Hypoglycemia Confidence in Persons with Type 1 Diabetes Treated with Multiple Daily Insulin Injections (GOLD-3). Diabetes Technol Ther. 2018;20(4):274-84. doi: 10.1089/dia.2017.0363
34. Mirani M, Berra C, Finazzi S, et al. Inter-day glycemic variability assessed by continuous glucose monitoring in insulin-treated type 2 diabetes patients on hemodialysis. Diabetes Technol Ther. 2010;12(10):749-53. doi: 10.1089/dia.2010.0052
35. Heinemann L, Freckmann G, Ehrmann D, et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet. 2018;391(10128):1367-77. doi: 10.1016/S0140-6736(18)30297-6
36. Marbury TC, Ruckle JL, Hatorp V, et al. Pharmacokinetics of repaglinide in subjects with renal impairment. Clin Pharmacol Ther. 2000;67(1):7-15. doi: 10.1067/mcp.2000.103973
37. Hasslacher C; Multinational Repaglinide Renal Study Group. Safety and efficacy of repaglinide in type 2 diabetic patients with and without impaired renal function. Diabetes Care. 2003;26(3):886-91.
38. Terawaki Y, Nomiyama T, Akehi Y, et al. The efficacy of incretin therapy in patients with type 2 diabetes undergoing hemodialysis. Diabetol Metab Syndr. 2013;5(1):10. doi: 10.1186/1758-5996-5-10
39. Osonoi T, Saito M, Tamasawa A, et al. Effect of hemodialysis on plasma glucose profile and plasma level of liraglutide in patients with type 2 diabetes mellitus and end-stage renal disease: a pilot study. PLoS One. 2014;9(12):e113468. doi: 10.1371/journal.pone.0113468
40. Idorn T, Knop FK, Jørgensen MB, et al. Safety and Efficacy of Liraglutide in Patients With Type 2 Diabetes and End-Stage Renal Disease: An Investigator-Initiated, Placebo-Controlled, Double-Blind, Parallel-Group, Randomized Trial. Diabetes Care. 2016;39(2):206-13. doi: 10.2337/dc15-1025
41. Park SH, Nam JY, Han E, et al. Efficacy of different dipeptidyl peptidase-4 (DPP-4) inhibitors on metabolic parameters in patients with type 2 diabetes undergoing dialysis. Medicine (Baltimore). 2016;95(32):e4543. doi: 10.1097/MD.0000000000004543
42. Nakamura Y, Hasegawa H, Tsuji M, et al. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors. World J Diabetes. 2015;6(6):840-9. doi: 10.4239/wjd.v6.i6.840
43. Padmanabhan A, Velayudham B, Vijaykumar N, et al. Evaluation of glycemic status during the days of hemodialysis using dialysis solutions with and without glucose. Saudi J Kidney Dis Transpl. 2018;29(5):1021-7. doi: 10.4103/1319-2442.243951
44. Burmeister JE, Miltersteiner Dda R, Burmeister BO, et al. Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia. Arch Endocrinol Metab. 2015;59(2):137-40. doi: 10.1590/2359-3997000000026
45. Burmeister JE, Scapini A, da Rosa Miltersteiner D, et al. Glucose-added dialysis fluid prevents asymptomatic hypoglycaemia in regular haemodialysis. Nephrol Dial Transplant. 2007;22(4):1184-9. doi: 10.1093/ndt/gfl710
46. Raimann JG, Kruse A, Thijssen S, et al. Metabolic effects of dialyzate glucose in chronic hemodialysis: results from a prospective, randomized crossover trial. Nephrol Dial Transplant. 2012;27(4):1559-68. doi: 10.1093/ndt/gfr520
ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
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K.G. Lobanova, A.S. Severina, S.A. Martinov, M.Sh. Shamkhalova, M.V. Shestakova
Endocrinology Research Centre, Moscow, Russia