Practical Use of Continuous Glucose Monitoring to Adjust Glucose-Lowering Therapy in Hemodialysis Patients: A Case Series

INTRODUCTION: Diabetes management in hemodialysis patients is complicated by limited treatment options and challenges in glycemic monitoring. Continuous glucose monitoring (CGM) provides detailed glucose profiles, enabling tailored glucose-lowering therapy.

METHODS: This case series presents three insulin-treated hemodialysis patients with type 1 or type 2 diabetes.

FINDINGS: Each case reveals significant glycemic abnormalities, including excessive hyperglycemia with nocturnal glucose drops, unrecognized hypoglycemia, and extreme glucose variability. We propose specific personalized insulin adjustments based on CGM readings to optimize treatment across these different clinical scenarios.

CONCLUSIONS: The case series highlights the potential to rethink glucose monitoring in hemodialysis patients with diabetes and underlines the need for future studies evaluating CGM use in this population.