Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2024; 15(4): 591-597
Published online Apr 15, 2024. doi: 10.4239/wjd.v15.i4.591
Application and management of continuous glucose monitoring in diabetic kidney disease
Xin-Miao Zhang, Quan-Quan Shen
Xin-Miao Zhang, Geriatric Medicine Center, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
Quan-Quan Shen, Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
Author contributions: Zhang XM drafted the manuscript; Shen QQ designed the research and revised the manuscript; all authors have read and approved the final manuscript.
Supported by Natural Science Foundation of Zhejiang Province, No. LY23H050005; and Zhejiang Medical Technology Project, No. 2022RC009.
Conflict-of-interest statement: We have no financial relationships to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Quan-Quan Shen, MD, Associate Professor, Doctor, Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China. spring198457@sina.com
Received: December 10, 2023
Peer-review started: December 10, 2023
First decision: January 25, 2024
Revised: February 1, 2024
Accepted: March 1, 2024
Article in press: March 1, 2024
Published online: April 15, 2024
Abstract

Diabetic kidney disease (DKD) is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease (ESKD). Wide glycemic var-iations, such as hypoglycemia and hyperglycemia, are broadly found in diabetic patients with DKD and especially ESKD, as a result of impaired renal metabolism. It is essential to monitor glycemia for effective management of DKD. Hemoglobin A1c (HbA1c) has long been considered as the gold standard for monitoring glycemia for > 3 months. However, assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction. Continuous glucose monitoring (CGM) has provided new insights on glycemic assessment and management. CGM directly measures glucose level in interstitial fluid, reports real-time or retrospective glucose concentration, and provides multiple glycemic metrics. It avoids the pitfalls of HbA1c in some contexts, and may serve as a precise alternative to estimation of mean glucose and glycemic variability. Emerging studies have demonstrated the merits of CGM for precise monitoring, which allows fine-tuning of glycemic management in diabetic patients. Therefore, CGM technology has the potential for better glycemic monitoring in DKD patients. More research is needed to explore its application and management in different stages of DKD, including hemodialysis, peritoneal dialysis and kidney transplantation.

Keywords: Diabetic kidney disease, Continuous glucose monitoring, Glycemic monitoring, Hemodialysis, Peritoneal dialysis, Kidney transplantation

Core Tip: Continuous glucose monitoring (CGM) shows the strength of providing a glycemic profile in diabetic kidney disease (DKD). This article summarizes the use of CGM in early and advanced stages of DKD, including hemodialysis, peritoneal dialysis, and kidney transplantation. CGM may be considered an alternative or complement to measurement of hemoglobin A1c in some contexts.