Person-reported and continuous glucose monitoring (CGM) recorded hypoglycaemia in people with insulin-treated type 2 diabetes and mild to moderate chronic kidney disease; post hoc analysis from the Hypo-METRICS study

Abstract

Background & aims People with diabetes and chronic kidney disease (CKD) may be at increased risk of iatrogenic hypoglycaemia. We compared rates of sensor-detected (SDH) and person-reported hypoglycaemia (PRH) in people with insulin-treated type 2 diabetes (T2D) with and without CKD in the Hypo-METRICS study. Materials & Method Insulin-treated T2D patients with >1 hypoglycaemic episode within the last three months wore a blinded continuous glucose monitor (CGM) and recorded PRH on the bespoke Hypo-METRICS app for ten weeks. SDH was defined as per consensus guidelines. The participants were grouped based on estimated glomerular filtration rate (eGFR), i.e. CKD 1 (eGFR≥90 ml/min; n=117), CKD 2 (eGFR 60-89 ml/min; n=140), and CKD 3 (eGFR 30-59 ml/min; n=56). We used descriptive statistics, Kruskal-Wallis rank sum tests, and a negative binomial models to control for confounders. Results In total, 313 participants with T2DM were included. Median age increased with declining eGFR (p < 0.001). Median (IQR) events per week for SDH <3.9 mmol/L were 1.72 (0.66–3.43) in CKD 1, 2.12 (0.85–4.55) in CKD 2, and 2.22 (1.09–4.57) in CKD 3 (p=0.12). For SDH <3.0 mmol/L, these rates were 0.20 (0.00–0.50), 0.21 (0.10–0.61), and 0.20 (0.00–0.71), respectively (p=0.88). PRH events had medians of 1.05 (0.40–2.12), 1.31 (0.61–2.42), and 1.28 (0.68–2.25) for CKD 1, CKD 2, and CKD 3 (p=0.24). Conclusion In people with insulin-treated T2DM and CKD stages 2 or 3, the rates of SDH and PRH do not significantly differ from those in people without CKD. The study was registered on ClinicalTRials.gov (NCT04304963).