الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Type 2 diabetes patients on chronic hemodialysis have a high prevalence of cardiovascular complications and often show a poor glycemic control. Single-spot glycemic measurements are not always meaningful, and the hemoglobin A1c value does not reflect short-term variations in glucose metabolism in this patient category. The measurement of glycemia in subjects with renal failure, treated with hemodialysis, or peritoneal dialysis, is clinically relevant, since glucose levels may influence the determination of other solutes, such as creatinine, as well as some ions, such as sodium, whose degree of removal during dialysis sessions should be controlled carefully. Also, glucose levels should be controlled to avoid possible events of hypoglycemia during the treatment, especially in diabetic subjects. Indeed, even cases of hypoglycemic coma are documented. Recent evidences suggest that hemodialysis induces glycemic variations in diabetic patients. Continuous glucose monitoring devices measure interstitial glucose in a ‘Holter-like’ manner thereby improving the glycemic control assessment method. This study aimed to Determine the actual state of inter day glycemic variability after initiation of HD by Continuous Glucose Monitoring System over a period of 2 days, including the dialysis day (HD) and the following inter-dialytic period ”free” day [FD]. Also, to study the relation between this glucose variability and blood glucose profiles (fasting blood glucose, postprandial blood glucose, and HbA1c) and to assess their value as a therapy guide in patients on hemodialysis. To identify the factors affecting this glycemic variability among diabetic patients on hemodialysis. To elucidate our aim, 20 types 2 diabetic patients diagnosed as an ESRD on hemodialysis was recruited from Diabetes and Endocrinology and Nephrology units in Menoufia university Hospital.
All patients were selected according to the inclusion and exclusion criteria:
Inclusion criteria: type 2 diabetes, ongoing insulin therapy for at least 3 months and stable hemoglobin level during the last 3 months.
Exclusion criteria: Patients on peritoneal dialysis, smokers, pregnant women, also, patients with malignancies, liver diseases, severe inflammatory or severe concomitant diseases, heart failure and hemoglobin anomalies.
For every patient the following was done: Full history taking including: Age, sex, smoking, duration of diabetes, history of hypertension, history of dyslipidemia, and other Co morbidities. dialysis session details; duration, ultrafiltration rate and volume, dialysis flow rate, intradialytic BP variability, medications (oral anti-diabetic agents or insulin therapy) and dialysis session details: duration, ultrafiltration rate and volume, dialysis flow rate, intradialytic BP variability and BW before and after the session. Clinical examination including: BMI, heart rate, blood pressure and mean artery blood pressure. Routine laboratory investigations including: Fasting blood glucose, 2-h postprandial blood glucose, HbA1c, Lipid profile, Complete blood picture, Serum urea, S. creatinine, estimated glomerular filtration rate and glucose level in dialytic fluid. our patients were subjected to 48-h Continuous glucose monitoring which is a new measure available using a sensitive patient.
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Summary
Results of the current study could be summarized as follows:
The mean of age, duration of diabetes mellitus, body weight before session, body weight after session, heart rate, systolic blood pressure and diastolic blood pressure of the studied patients were 61.95±11.14, 8.75±4.07, 87.40±13.26, 84.06±13.15, 80.25 ± 5.45, 127.0 ± 11.28 and 79.50 ± 8.25, respectively.
The mean of ultrafiltration rate, filtration volume, dialysis flow rate and interdialytic bp variability of the studied patients were 366.30 ± 350.21, 381.90± 216.50, 242.0± 24.62 and 14.16± 8.78, respectively.
The mean of triglycerides, cholesterol, LDL, HDL, FBG, HBA1c, serum creatinine, serum urea, albumin, HB, PLT and WBCs of the studied patients were 161.88 ± 65.58, 183.80 ± 70.03, 112.55 ± 57.48, 41.55 ± 11.58, 106.70 ± 42.84, 6.06 ± 1.15, 7.23 ± 2.26, 119.15 ± 36.78, 3.16 ± 0.36, 8.80 ± 1.73, 230.25 ± 77.56 and 10.61 ± 4.68, respectively.
The blood glucose status at days off (Day 1 and Day 3), that hyper blood glucose at day 3 was increased in day 3 (FD) than day 1 according to the hours except at seven o’clock. While hyper blood glucose at days on (Day 2 and Day 4) was increased in day 2 than day 4 according to the hours.
Blood glucose status was increased inside MAGE than outside MAGE according to the hours.
The mean of MAGE level of the studied patients at the dialysis day (day 2 and day 4) were 233.72±39.48 and 178.01±36.62, while, at the free day (day 1 and day 3) were 230.57±39.81 and 263.81±34.39, respectively