The Application Of Hypoglycemia Management In Patients With Diabetes Undergoing Maintenance Hemodialysis

Purpose: To investigate the present levels of blood glucose and hypoglycemia in hemodialysed type 2 diabetic patients under the routine care.To evaluate the effect of hypoglycemia management intervention on reducing the incidence of hypoglycemia and hyperglycemia,stabilizing blood glucose levels during dialysis.Methods: A self-control study was used in this study.85 cases of type 2 diabetic patients were selected from the hemodialysis unit in a hospital,receiving the routine care and hypoglycemia management intervention successively.Plasma glucose levels were measured at pre-dialysis,1h,2h,3h,end of dialysis.Social demographics and disease-related data were collected at the time of enrollment,the data of eating and blood glucose were completed at the phase of the routine care intervention and hypoglycemia management intervention respectively.Blood glucose levels and the frequency of hypoglycemia and hyperglycemia were analyzed at each point in time during two interventions,in order to evaluate the feasibility and effectiveness of hypoglycemia management intervention to improve research indicators of hemodialysed type 2 diabetic patients.Results:1.A total of 82 subjects completed all data collection.2.Nearly half(42.7%)of patients' eating time were different on the day on dialysis and on the day off dialysis,there were no difference in the type and amount of food.Almost all(96.3%)patients tented to eat during dialysis.3.The incidence of hypoglycemia of blood glucose in the range of 6 ~ 8mmol/L were were significantly lower than 4 ~6mmol/L at pre-dialysis,1h,2h and 3h(P<0.05).4.No significant differences were found between patients having hypoglycemia and not having hypoglycemia at at baseline(P>0.05).At pre-dialysis,1h,2h,3h and whole dialysis period,the blood glucose levels of patients not having hypoglycemia were significantly higher than having hypoglycemia(P<0.05).5.There were no difference in the number and amount of food intaking between hypoglycemia management and the routine care intervention(P>0.05).The eating time of patients received hypoglycemia management were less than that of routine care(P<0.05).6.The differences of blood glucose values at each time point were statistically significant during two interventions(P<0.05),but no differences were found between two different interventions.Besides,the comparison of glycemic variability at two adjacent point showed no significant difference(P>0.05).7.Compared with the routine care intervention,the incidence of hypoglycemia on dialysis period and the day off dialysis declined obviously by hypoglycemia management intervention(P<0.05).There were no difference in the incidence of hyperglycemia between two interventions(P>0.05).Conclusions:1.In this study,the eating time of subjects on the day on dialysis was earlier than the day off dialysis,the type and amount of food needs to be further investigated.2.In this study,with the progress of dialysis,blood glucose levels dropped the most in the first hour,reached the bottom at 2h.Patients whose blood glucose values ?6.0mmol/L at pre-dialysis,1h,2h and 3h were more likely to have hypoglycemia.3.Compared with patients not having hypoglycemia,the blood glucose level of patients having hypoglycemia decreased significantly during dialysis.4.In this study,hypoglycemia management intervention failed to improve the blood glucose levels during dialysis.5.Compared to the routing care intervention,hypoglycemia management intervention can reduce the incidence of hypoglycemia during hemodialysis and on the day off dialysis.6.In this study,hypoglycemia management intervention failed to reduce the incidence of hyperglycemia during dialysis,and its application effect needs to be further demonstrated.