The Analysis Of Blood Glucose Level In Diabetics Patients During Hemodialysis

AimsWith the rapid increase of diabetes in the world,the proportion of patients with end-stage diabetes hemodialysis will also increase in China.During the hemodialysis,the change of blood glucose in diabetic patients is larger than that of non-diabetic patients.And the fluctuation of blood glucose is not conducive to the prognosis of patients.The purpose of this study is to obtain the blood glucose data of diabetic patients and analyze the changes of blood glucose during maintenance hemodialysis.MethodsFrom August 2018 to January 2019,blood glucose levels of diabetic patients during dialysis were monitored at two hemodialysis centers in Jiangsu province.The blood glucose values were monitored at 5 time points,including pre-hemodialysis,the first hour dialysis(1^sth),the second hour dialysis(2^ndh),the third hour dialysis(3^rdh)and the end of dialysis.And blood glucose levels were detected for three consecutive times.The blood samples were from the arterial line.The frequency of hyperglycemia and hypoglycemia at different time points,the blood glucose level at pre-hemodialysis,1^sth,2^ndh,3^rdh and the end of dialysis,the indicators of glucose variation（SDBG,LAGE,CV）,and the correlation between GA,HbA1c and the average blood glucose level during dialysis were all analyzed,.Data analysis was carried out using the Statistical Package for Social Sciences（SPSS）version 22.0.The results were considered statistically significant if two sides<0.05.Results1 With the progress of hemodialysis,patient’s blood glucose levels gradually decreased.The largest decrease was at the first hour of dialysis and the lowest blood glucose level was at the end of dialysis.After the second hours,the changes of blood glucose were small and stable.2 The results of repeated measurement variance analysis of blood glucose levels at different time points during the three times of dialysis showed that,the single dialysis showed<0.001,indicating that the difference of blood glucose data at different time points was statistically significant.There was no significant difference in blood glucose among the subjects after three times of dialysis（>0.05）.And there was no interaction between time and times of dialysis（>0.05）.There were indexes of blood glucose variability.LAGE was 5.94±3.43,SDBG was 2.40±1.39,CV was 0.24±0.10,And both LAGE and SDBG were greater than the normal reference range.3 During the three hemodialysis sessions,the incidence of hypoglycemia was 8.6%（5 patients）,6.9%（4 patients）and 10.3%（6 patients）respectively.The most of hypoglycemia was asymptomatic hypoglycemia（66.7%）.The incidence of hyperglycemia was 32.8%（19 patients）,39.7%（23 patients）,and 29.3%（17 patients）respectively.The pre-hyperglycemia was predominant in hyperglycemia（58.6%）.4 The blood glucose values and blood glucose variability at different time points between the hypoglycemia group and the non-hypoglycemia group were compared.The results showed that,the blood glucose levels of the hypoglycemia group were lower than that of the non-hypoglycemia group at the five time points and the mean blood glucose.The difference was statistically significant（<0.05）.In terms of blood glucose variability indicators,and the coefficient variation was higher than non-hypoglycemic group.The differences were statistically significant（<0.05）.While the largest amplitude of glycemic excursions and the standard deviation of blood glucose were not different（>0.05）.5 There was a positive correlation between GA,HbA1c and mean blood glucose level.The correlation between HbA1c and mean blood glucose level was weak and significantly lower than GA and average blood glucose level（=0.291 VS=0.641）.GA was positively correlated with the mean blood glucose value at five time points during dialysis（<0.001）,while HbA1c only has a positive correlation with the pre-dialysis,2^ndh,and end of dialysis（<0.05）.And the correlation coefficient is low.The difference was not found in other two points(1^sth and 3^rdh).6 The general data between the group with good blood glucose control（GA<21.705%）and the group with poor blood glucose control（GA>21.705%）was compared.The results showed that,the age,duration of diabetes（years）and dialysis age（months）of the group with poor blood glucose control were higher than the group with good blood glucose control.The difference was statistically significant（<0.05）.Comparison of blood glucose data（GA,HbA1c,MBG,LAGE,SDBG）:the group with poor blood control was significantly higher than the group with good glucose control,and the difference was statistically significant（<0.05）.Conclusions1 During hemodialysis,the blood glucose dropped the fastest at the first hour.And from the second hour to the end of hemodialysis,it changed stable.Blood glucose variability was greater than normal.2 The incidence of hypoglycemia and hyperglycemia is high.In hypoglycemia,the majority is asymptomatic hypoglycemia,while in hyperglycemia,the majority is pre-hemodialysis hyperglycemia.3 Compared with HbA1c,GA has a better correlation with the mean blood glucose level.And it is more suitable for evaluating the blood glucose control of diabetic patients with hemodialysis.