Use of Continuous Glucose Monitoring (CGM) in End-Stage Renal Disease (ESRD) Patients with Type 2 Diabetes

项目总结/摘要 糖尿病影响高达40%的终末期肾病（ESRD）患者。糖尿病 由于葡萄糖的改变，现有ESRD背景下的管理具有挑战性 代谢、胰岛素敏感性以及几种药物的肾清除率。所以大多数 接受透析的糖尿病患者接受胰岛素治疗， 低血糖住院率、死亡率、住院时间和住院费用 水平在许多情况下，临床医生和患者需要根据很少的 每天的床旁血糖（POC BG），无法检测无症状和 夜间低血糖并不是24小时血糖波动的良好指标。 新型工厂校准的连续葡萄糖监测（CGM）设备已经显示出改善的 准确性，可以满足透析中对更好的血糖监测系统的关键需求 患者在本提案中，PI Galindo博士将使用CGM（目标1a）检查患病率 低血糖，高血糖和估计血糖变异模式的患者， 2型糖尿病（DM 2），接受胰岛素治疗和血液透析，（目的1b），以评估 该特定队列中CGM的准确性（目的2a），以评估实时CGM的有效性 在预防低血糖和高血糖方面的数据，以及（目的2b）检查 血糖变异性和炎症/氧化应激标志物之间的关系 在目标2a中。我们预计，这项研究将提供新的见解血糖暴露 透析患者中的模式，并将为未来基于结果的 研究确定这一群体的最佳血糖目标。加林多博士创造了一个 由Umpierrez博士领导的具有NIH资助记录的多学科导师团队， 在葡萄糖监测和研究方法的专业知识，和塔特尔博士，谁是专家， 糖尿病肾病的临床和转化研究。他的科学顾问委员会 包括生物统计学和生物信息学专家（彭利民博士），以及CGM专家。 贝克博士（Dr. Beck）加林多博士将在庞大的资源范围内测试所提出的目标 埃默里大学是世界著名的研究机构。职业发展计划 包括教学课程，基于指导的临床研究培训和实践 CGM使用经验和大型数据库分析。这一创新的建议和正式的 培训计划，将为加林多博士提供未来R 01应用的基础， 独立从事以病人为中心的临床研究。

Project Summary/Abstract Diabetes affects up to 40% of patients with end-stage renal disease (ESRD). Diabetes management in the context of existing ESRD is challenging due to alterations on glucose metabolism, insulin sensitivity, and also renal clearance of several medications. Thus, most patients with diabetes on dialysis are treated with insulin therapy, resulting in increased risk for hospitalizations for hypoglycemia, mortality, length-of-stay and hospitalization costs at a national level. In many instances, clinicians and patients need to make treatment decisions based on few point-of-care blood glucoses (POC BG) per day, which fails to detect asymptomatic and nocturnal hypoglycemia and are not a good indicator of the 24-hours glycemic excursions. Novel factory-calibrated continuous glucose monitoring (CGM) devices have shown improved accuracy and could fill the critical need for better glycemic monitoring systems in dialysis patients. In this proposal, the PI, Dr. Galindo, will use CGM (Aim 1a) to examine the prevalence of hypoglycemia, hyperglycemia and estimate glycemic variability patterns among patients with type 2 diabetes (DM2), treated with insulin and receiving hemodialysis, (Aim 1b) to assess the accuracy of the CGM in this specific cohort, (Aim 2a) to assess the efficacy of real-time CGM data in preventing hypoglycemia and hyperglycemia, and (Aim 2b) to examine the relationship between glycemic variability and inflammatory/oxidative stress markers in patients participating in Aim 2a. We anticipate that this study will provide novel insights into the glycemic exposure patterns among dialysis patients and will provide preliminary data for future outcomes-based studies determining the best glycemic targets for this group. Dr. Galindo has created a multidisciplinary mentorship team with track record of NIH funding, led by Dr. Umpierrez, with expertise in glucose monitoring and research methodology, and Dr. Tuttle, who is an expert on clinical and translational studies in diabetic kidney disease. His scientific advisory committee includes experts in biostatistics and bioinformatics (Dr. Limin Peng, PhD), and in CGM technology for (Dr. Beck). Dr. Galindo will test the proposed aims within the vast resources available at Emory University - a world-known research institution. The career development plan includes didactic classes, mentored-based training on clinical research and hands-on experience on CGM use and large database analyses. This innovative proposal and formal training plan, will provide Dr. Galindo with the bases for future R01 applications, and an independent career in patient-oriented clinical research.