Adequacy of Glycemic Control in Hemodialysis Patients With Diabetes

Adequacy of Glycemic Control in Hemodialysis Patients With Diabetes Daniel J. Tascona , MD , A. Ross Morton , MD , Edwin B. Toffelmire , MD , David C. Holland , MD and Eduard A. Iliescu , MD From the Division of Nephrology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada Address correspondence and reprint requests to Eduard A. Iliescu, Queen’s University, 2058 Etherington Hall, Kingston, Ontario, Canada, K7L 3N6. E-mail: eai1{at}post.queensu.ca Abstract OBJECTIVE —We sought to measure the prevalence of inadequate glycemic control in prevalent hemodialysis patients with diabetes and to examine independent predictors of inadequate glycemic control in these patients. RESEARCH DESIGN AND METHODS —This is a cross-sectional study of prevalent hemodialysis patients with diabetes in southeastern Ontario ( n = 100). Data were collected by chart review and interview. The outcome variable was inadequate glycemic control defined as HbA 1c (A1C) >0.07. Other measured variables were diabetes type, diabetes duration, diabetes physician, blood glucose monitoring, diabetes medications, BMI, time on dialysis, and other demographic, clinical, and laboratory variables. RESULTS —Fifty-four patients had A1C >0.07. In bivariate analysis, these patients had a longer diabetes duration (23.6 vs.14.7 years, P < 0.001), higher proportion with insulin use (81.5 vs. 58.7%, P = 0.012), higher proportion with microvascular complications (66.7 vs. 43.5%, P = 0.017), and lower erythropoietin (EPO) dose (7.0 vs. 11.9 × 10 3 units/week, P < 0.01) than patients with adequate glycemic control. There was no difference between the two groups in terms of macrovascular complications (59.3 vs. 65.2%, P = 0.54). In multiple logistic regression controlling for age and diabetes type, the diabetes duration (odds ratio 1.09 [95% CI 1.04–1.15], P < 0.001), EPO dose (0.90 [0.85–0.97], P < 0.01), and blood glucose monitoring (10.06 [1.03–98.74], P = 0.05) were the only significant independent predictors of A1C >0.07. CONCLUSIONS —A high proportion of hemodialysis patients with diabetes had inadequate glycemic control, particularly those with longstanding disease. Patients with inadequate glycemic control had a significantly higher burden of microvascular complications. CKD, chronic kidney disease DCCT, Diabetes Control and Complications Trial EPO, erythropoietin ESKD, end-stage kidney disease KGH, Kingston General Hospital UKPDS, U.K. Prospective Diabetes Study Footnotes A table elsew