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Prospective Study
Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Diabetes. Mar 15, 2026; 17(3): 115771
Published online Mar 15, 2026. doi: 10.4239/wjd.v17.i3.115771
Impact of visceral adiposity on glycemic variability in patients with insulin-treated type 2 diabetes undergoing hemodialysis
Pedro Gil-Millán, Ascensión Lupiañez, Sonia Caparrós, Alicia Ribas, Shaira Martínez-Vaquera, Ángel Ortiz-Zuñiga, Cristina Hernández, Rafael Simó, Olga Simó-Servat
Pedro Gil-Millán, Ángel Ortiz-Zuñiga, Cristina Hernández, Rafael Simó, Olga Simó-Servat, Department of Endocrinology, Hospital Vall d´Hebron, Barcelona 08035, Catalonia, Spain
Pedro Gil-Millán, Department of Endocrinology, Diaverum España, Barcelona 08030, Catalonia, Spain
Pedro Gil-Millán, Department of Ciberdem, Instituto de Salud Carlos III, Madrid 28029, Spain
Ascensión Lupiañez, Department of Nutrition, Diaverum España, Barcelona 08030, Catalonia, Spain
Sonia Caparrós, Shaira Martínez-Vaquera, Department of Nephrology, Diaverum España, Barcelona 08030, Catalonia, Spain
Alicia Ribas, Department of Nurse, Diaverum España, Barcelona 08030, Catalonia, Spain
Ángel Ortiz-Zuñiga, Cristina Hernández, Rafael Simó, Olga Simó-Servat, Department of Ciberdem, Instituto Carlos III, Madrid 28029, Spain
Author contributions: Gil-Millán P was responsible for conceptualization, patient follow-up, statistical analyses, manuscript drafting, and editing; Lupiañez A was responsible for body composition assessments and supervision of multifrequency bioelectrical impedance analysis procedures; Caparrós S and Ribas A were responsible for patient follow-up and monitoring during hemodialysis sessions; Martínez-Vaquera S and Ortiz-Zuñiga A were responsible for statistical analyses and manuscript revision; Hernández C was responsible for conceptualization, supervision, manuscript editing, and funding acquisition; Simó R was responsible for conceptualization, supervision, manuscript writing, editing, and funding acquisition; Simó-Servat O was responsible for conceptualization, statistical analyses, manuscript writing, and editing; All authors read and approved the final version of the manuscript to be published.
Institutional review board statement: Approved by the Vall d’Hebron Ethics Committee, No. PR(AG)199/2024.
Clinical trial registration statement: This is a prospective study with no assigned intervention; therefore, clinical trial registration is not applicable.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Data are available from the corresponding author upon reasonable request.
Corresponding author: Pedro Gil-Millán, MD, Department of Endocrinology, Hospital Vall d´Hebron, Paseo de la Vall d'Hebron, 119-129, Barcelona 08035, Catalonia, Spain. pedroalejandro.gil@vallhebron.cat
Received: October 25, 2025
Revised: December 4, 2025
Accepted: January 28, 2026
Published online: March 15, 2026
Processing time: 138 Days and 21.3 Hours
Core Tip

Core Tip: We conducted a prospective study using 20 days of continuous glucose monitoring to better understand glycemic instability in insulin-treated type 2 diabetes patients undergoing hemodialysis. Our results show that low visceral fat area is a strong and independent determinant of larger fluctuations in time-in-range between dialysis and non-dialysis days. Patients with low visceral adiposity had higher mean glucose, lower time-in-range, and more pronounced post-dialysis hyperglycemia. Visceral fat was the only variable that remained significant after multivariate adjustment. These findings suggest that visceral adiposity may act as a metabolic buffer, and that patients with low visceral fat area represent a fragile phenotype who may benefit from closer monitoring and more personalized diabetes management in the hemodialysis.