Impact of visceral adiposity on glycemic variability in patients with insulin-treated type 2 diabetes undergoing hemodialysis

Table 1 Glucometrics data of type 2 diabetes with end-stage kidney disease between hemodialysis days and off-hemodialysis for 20 days, mean ± SD

Glucometrics by continuous glucose monitoring	HD	Off-HD	P value
Mean continuous glucose monitoring (mg/dL)	172.15 ± 41.53	182.49 ± 48.92	0.004
SD (mg/dL)	52.93 ± 16.24	49.37 ± 15.59	0.004
Time in range (%)	62.68 ± 19.93	57.06 ± 23.05	0.008
TAR1 (> 180 mg/dL) (%)	22.72 ± 9.15	26.63 ± 10.61	0.017
TAR2 (> 250 mg/dL) (%)	13.41 ± 14.04	14.64 ± 17.97	0.17
TBR1 (< 70 mg/dL) (%)	1.65 ± 2.91	0.95 ± 1.27	0.25
TBR2 (< 54 mg/dL) (%)	0.75 ± 2.71	0.31 ± 0.70	0.60
Glucose management indicator vs glycated hemoglobin (%)	7.31 ± 0.78 vs 6.98 ± 1.38		0.001

HD: Hemodialysis; Off-HD: Non-hemodialysis days; SD: Standard deviation; TAR: Time above range; TBR: Time below range.

Table 2 Baseline characteristics among differences in time in range (< 5% vs > 5%) type 2 diabetes with end-stage kidney disease groups, n (%)/mean ± SD/median (interquartile range)

Clinical variables	ΔTIR < 5% (n = 17)	ΔTIR > 5% (n = 18)	P value
Age (years)	74.19 ± 7.22	71.65 ± 10.35	0.31
Sex (male/female)	37.5/62.5	72.2/27.8	0.29
Diabetes duration (years)	18.93 ± 7.03	17.87 ± 6.68	0.85
Insulin (UI/kg/day)	0.30 ± 0.14	0.39 ± 0.26	0.71
Insulin regime (basal bolus/insulin pre-mixed) (%)	52.90/47.10	77.77/22.22	0.27
Glucagon-like peptide-1 receptor agonist	2 (11.76)	2 (11.11)	0.73
Sodium-glucose cotransporter-2 inhibitor	2 (11.76)	1 (5.5)	0.46
Diabetic nephropathy (%)	75	83.3	0.70
Diabetic retinopathy (%)	56.3	64.7	0.49
Heart failure (%)	46.7	50	0.47
Cerebrovascular disease (%)	50	29.4	0.61
Peripheral vascular disease (%)	12.5	29.4	0.37
Diabetic polyneuropathy (%)	12.5	23.5	0.67
Abdominal waist (cm)	91.06 ± 12.51	73.50 ± 10.33	< 0.001
Dry weight (kg)	74.61 ± 15.76	64.91 ±15.97	0.06
Body mass index (kg/m2)	29.34 ± 6.58	24.56 ± 3.97	0.011
Waist-to-height ratio	0.56 ± 0.70	0.46 ± 0.60	0.001
Analytical variables
Hemoglobin (g/L)	11.63 ± 0.67	10.98 ± 1.40	0.45
Ferritin (ng/mL)	473.80 ± 218.30	333.24 ± 245.92	0.59
Glycated hemoglobin (%) (mmol/mol)	6.45 ± 0.79 (46.99 ± 8.63)	7.42 ± 1.62 (57.67 ± 17.71)	0.05
Triglycerides (mg/dL)	138.00 (86.00, 197.00)	114.00 (83.50, 164.00)	0.73
Parathyroid hormone (pg/mL)	440.60 ± 324.63	325.29 ± 258.24	0.41
Ca (mg/dL)	8.87 ± 0.56	8.72 ± 0.63	0.47
Pi (mg/dL)	4.50 ± 1.09	4.33 ± 1.30	0.14
Ca-Pi product (product)	40.13 ± 10.33	35.13 ± 10.63	0.24
Albumin (g/dL)	3.77 ± 0.24	3.67 ± 0.42	0.16
Systemic immune-inflammation Index	495.49 (394.86, 636.46)	650.65 (429.96, 1170.21)	0.80
Multifrequency bioelectrical impedance analysis
TBW (L)	36.13 ± 5.78	33.65 ± 4.99	0.43
Intracellular water (L)	21.99 ± 3.63	19.94 ± 3.42	0.27
ECW (L)	14.14 ± 2.16	14.40 ± 3.06	0.81
ECW/TBW ratio	0.391 ± 0.006	0.400 ± 0.018	0.10
Visceral fat area (cm2)	127.02 ± 49.52	63.40 ± 42.73	0.001
Total PA (degrees)	4.70 ± 0.62	4.16 ± 1.05	0.13
Chest PA (degrees)	7.54 ± 2.37	6.63 ± 2.53	0.19
Skeletal muscle index	7.65 ± 0.73	7.55 ± 1.49	0.63
Online hemodiafiltration
Vascular access (arteriovenous fistula/central venous catheter) (%)	37.5/62.5	52.9/47.1	0.63
Dialyzer (polysulfone /H-polymer) (%)	100	100	0.42
Dialyzer (1.9/2.1 m2) (%)	62.5/37.5	78.6/21.4	0.10
Weight pre-post hemodialysis (kg)	2.32 ± 0.66	2.29 ± 0.76	0.94
Substitution volume (L)	28.97 ± 9.24	27.37 ± 5.96	0.33
Arterial pressure (mmHg)	-143.75 ± 77.96	-144.79 ± 91.65	0.74
Venous pressure (mmHg)	157.18 ± 23.60	160.92 ± 21.71	0.86
Blood flow rate (mL/minute)	386.66 ± 16.72	371.11 ± 24.11	0.23
Dialysis adequacy/urea clearance	2.15 ± 0.40	1.98 ± 0.31	0.69

P < 0.05 considered statistically significant. Ca: Calcium; ECW: Extracellular water; PA: Phase angle; Pi: Phosphorus; TBW: Total body water; ΔTIR: Differences in time in range.

Table 3 Glucometrics between differences in time in range of patients with type 2 diabetes on hemodialysis and off-hemodialysis days, mean ± SD

	ΔTIR < 5%		ΔTIR > 5%
	HD	Off-HD	HD	Off-HD	P value
Mean continuous glucose monitoring (mg/dL)	158.55 ± 33.69	161.30 ± 35.80	187.09 ± 44.27	201.85 ± 52.26	1
SD (mg/dL)	48.70 ± 13.40	44.66 ± 10.51	60.91 ± 20.04	41.25 ± 9.56	0.53
TIR (%)	67.16 ± 19.44	64.91 ± 23.91	55.30 ± 16.48	48.73 ± 19.88	1
TAR1 (> 180 mg/dL) (%)	21.97 ± 10.55	23.21 ± 11.00	24.07 ± 7.68	30.11 ± 9.57	1
TAR2 (> 250 mg/dL) (%)	9.10± 12.75	9.56 ± 15.86	17.93 ± 14.27	19.96 ± 18.93	1
TBR1 (< 70 mg/dL) (%)	1.79 ± 1.90	1.23 ± 1.33	1.62 ± 3.70	0.76 ± 1.22	0.67
TBR2 (< 54 mg/dL) (%)	0.42 ± 1.0	0.29 ± 0.49	1.09 ± 3.69	0.35 ± 0.87	0.10
Coefficient of variation (%)	31.28 ± 5.79		34.26 ± 8.51		0.10
Glucose management indicator (%)	7.22 ± 0.80		8.02 ± 1.14		2

¹Differences found hemodialysis and off-hemodialysis days in differences in time in range > 5%.

²Differences found between differences in time in range groups.

HD: Hemodialysis; SD: Standard deviation; TAR: Time above range; TBR: Time below range; ΔTIR: Differences in time in range.