Assessment of Glycemic Control by Continuous Glucose Monitoring, Hemoglobin A1c, Fructosamine and Glycated Albumin in Patients with End-Stage Kidney Disease and Burnt-Out Diabetes

Background. Patients with diabetes and end-stage kidney disease (ESKD) may experience “burnt-out diabetes”, defined as having a HbA1c 6 months. Methods. This pilot prospective study assessed glycemic control by continuous glucose monitoring (Dexcom CGM), HbA1c, glycated albumin and fructosamine in patients with burnt-out diabetes (n=20) and without a history of diabetes (n=20).Results. Patients with burnt-out diabetes had higher CGM-measured daily glucose, lower % time in range 70-180 mg/dL, higher % time above range >250 mg/dL, and longer duration of hyperglycemia >180 mg/dL (hours/day) compared to patients without diabetes (all pConclusion. The use of CGM demonstrated that patients with burnt-out diabetes have significant undiagnosed hyperglycemia. CGM and glycated albumin provide better assessment of glycemic control than HbA1c and fructosamine in patients with ESKD. </p

A Randomized Controlled Trial Comparing the Efficacy and Safety of IDegLira versus Basal-Bolus in Patients with Poorly Controlled Type 2 Diabetes and Very High HbA1c > 9-15%: DUAL HIGH trial

Introduction: In participants with type 2 diabetes (T2D) and HbA1c >9.0-10.0%, guidelines recommend treatment with basal-bolus insulin.  Methods: Randomized trial comparing the efficacy and safety of IDegLira and basal-bolus among participants with high HbA1c >9.0-15.0%, previously treated with 2-3 oral agents and/or basal insulin, allocated (1:1) to basal-bolus (n=73) or IDegLira (n=72). Primary endpoint was non-inferiority (0.4%) in HbA1c reduction between groups.  Results: Among 145 participants (HbA1c 10.8%±1.3), there was no statistically significant difference in HbA1c reduction (3.18%±2.29 vs. 3.00%±1.79, p=0.65, ETD 0.18%, 95%CI: -0.59, 0.94); between IDegLira and basal-bolus group. IDegLira resulted in significantly lower rates of hypoglycemia Conclusions: In participants with T2D and HbA1c >9.0-15.0%, IDegLira resulted in similar HbA1c reduction, less hypoglycemia, less weight gain, compared to basal-bolus regimen. </p

Table_1_Quality of dietary macronutrients is associated with glycemic outcomes in adults with cystic fibrosis.DOCX

ObjectivePoor diet quality contributes to metabolic dysfunction. This study aimed to gain a greater understanding of the relationship between dietary macronutrient quality and glucose homeostasis in adults with cystic fibrosis (CF).DesignThis was a cross-sectional study of N = 27 adults with CF with glucose tolerance ranging from normal (n = 9) to prediabetes (n = 6) to being classified as having cystic fibrosis-related diabetes (CFRD, n = 12). Fasted blood was collected for analysis of glucose, insulin, and C-peptide. Insulin resistance was assessed by Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR). Subjects without known CFRD also underwent a 2-h oral glucose tolerance test. Three-day food records were used to assess macronutrient sources. Dietary variables were adjusted for energy intake. Statistical analyses included ANOVA, Spearman correlations, and multiple linear regression.ResultsIndividuals with CFRD consumed less total fat and monounsaturated fatty acids (MUFA) compared to those with normal glucose tolerance (p DiscussionImprovements in diet quality are needed in people with CF. This study suggests that higher unsaturated dietary fat, higher plant protein, and higher carbohydrate quality were associated with better glucose tolerance indicators in adults with CF. Larger, prospective studies in individuals with CF are needed to determine the impact of diet quality on the development of CFRD.</p