Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring
Optimized glycemic management is crucial for controlling atherosclerosis and consequent cardiovascular morbidity in patients with diabetes. Due to the continuous glucose burden from glucose-containing peritoneal dialysis (PD) solutions, PD patients with diabetes experience difficulties in glucose le...
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MDPI AG
2025-05-01
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| author | Aleksandra Kezić Selena Gajić Ana Račić Ostojić Ivana Bekić Ana Bontić Jelena Pavlović Marko Baralić Ljiljana Popović |
| author_facet | Aleksandra Kezić Selena Gajić Ana Račić Ostojić Ivana Bekić Ana Bontić Jelena Pavlović Marko Baralić Ljiljana Popović |
| author_sort | Aleksandra Kezić |
| collection | DOAJ |
| description | Optimized glycemic management is crucial for controlling atherosclerosis and consequent cardiovascular morbidity in patients with diabetes. Due to the continuous glucose burden from glucose-containing peritoneal dialysis (PD) solutions, PD patients with diabetes experience difficulties in glucose level regulation with glucose hypervariability and worsening dyslipidemia. Even in non-diabetic PD patients, glucose-containing PD solutions aggravate insulin resistance and cause overweight. Additionally, glucose degradation products (GDP) from glucose-based PD solutions provoke oxidative stress and complex inflammatory processes, leading to chronic deleterious and fibrotic peritoneal membrane changes. In this narrative review, we searched the literature using PubMed, MEDLINE, and Google Scholar over the last three decades to summarize the most important facts relevant to the presented issues, aiming to inform both endocrinologists and nephrologists in providing the best currently available care for people with diabetes on PD. We not only focus on adequate tailoring of insulin therapy adapted at the time of PD exchange with hypertonic glucose solution., but also emphasize the use of continuous glucose monitoring (CGM) that allows assessment of mean glucose values and time spent in normal, hypo, and hyperglycemia. However, the routine use of CGM in PD patients is limited due to high cost, and hemoglobin A1c (HbA1c) analysis is still recommended as a basic clinical tool for the assessment of glycemic control. Possible choices of antidiabetic drugs were considered given the narrowed choice due to contraindications for metformin and sulfonylurea. The other important therapeutic approach in PD patients with diabetes is using glucose-sparing PD regimens based on icodextrin and amino acid PD solutions with the addition of just one or two bags of low glucose concentration PD solution daily. This glucose-sparing approach not only reduces the glucose load and improves glycoregulation with correction of the lipid profile but also maintains the viability of the peritoneal membrane by reducing the harmful effects of GDPs. |
| format | Article |
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| institution | OA Journals |
| issn | 2075-1729 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Life |
| spelling | doaj-art-bf6fa1d9f29a44f88c43becd9715396f2025-08-20T02:33:47ZengMDPI AGLife2075-17292025-05-0115579810.3390/life15050798Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose MonitoringAleksandra Kezić0Selena Gajić1Ana Račić Ostojić2Ivana Bekić3Ana Bontić4Jelena Pavlović5Marko Baralić6Ljiljana Popović7Clinic of Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, SerbiaClinic of Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, SerbiaDepartment of Nephrology, Clinical Hospital Center Zemun, Vukova 9, 11080 Belgrade, SerbiaChildren’s Hospital for Lung Diseases and Tuberculosis, Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Heroja Milana Tepića 1, 11000 Belgrade, SerbiaClinic of Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, SerbiaClinic of Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, SerbiaClinic of Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, SerbiaFaculty of Medicine, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, SerbiaOptimized glycemic management is crucial for controlling atherosclerosis and consequent cardiovascular morbidity in patients with diabetes. Due to the continuous glucose burden from glucose-containing peritoneal dialysis (PD) solutions, PD patients with diabetes experience difficulties in glucose level regulation with glucose hypervariability and worsening dyslipidemia. Even in non-diabetic PD patients, glucose-containing PD solutions aggravate insulin resistance and cause overweight. Additionally, glucose degradation products (GDP) from glucose-based PD solutions provoke oxidative stress and complex inflammatory processes, leading to chronic deleterious and fibrotic peritoneal membrane changes. In this narrative review, we searched the literature using PubMed, MEDLINE, and Google Scholar over the last three decades to summarize the most important facts relevant to the presented issues, aiming to inform both endocrinologists and nephrologists in providing the best currently available care for people with diabetes on PD. We not only focus on adequate tailoring of insulin therapy adapted at the time of PD exchange with hypertonic glucose solution., but also emphasize the use of continuous glucose monitoring (CGM) that allows assessment of mean glucose values and time spent in normal, hypo, and hyperglycemia. However, the routine use of CGM in PD patients is limited due to high cost, and hemoglobin A1c (HbA1c) analysis is still recommended as a basic clinical tool for the assessment of glycemic control. Possible choices of antidiabetic drugs were considered given the narrowed choice due to contraindications for metformin and sulfonylurea. The other important therapeutic approach in PD patients with diabetes is using glucose-sparing PD regimens based on icodextrin and amino acid PD solutions with the addition of just one or two bags of low glucose concentration PD solution daily. This glucose-sparing approach not only reduces the glucose load and improves glycoregulation with correction of the lipid profile but also maintains the viability of the peritoneal membrane by reducing the harmful effects of GDPs.https://www.mdpi.com/2075-1729/15/5/798diabetes mellitusperitoneal dialysisicodextrincontinuous glucose monitoring |
| spellingShingle | Aleksandra Kezić Selena Gajić Ana Račić Ostojić Ivana Bekić Ana Bontić Jelena Pavlović Marko Baralić Ljiljana Popović Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring Life diabetes mellitus peritoneal dialysis icodextrin continuous glucose monitoring |
| title | Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring |
| title_full | Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring |
| title_fullStr | Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring |
| title_full_unstemmed | Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring |
| title_short | Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring |
| title_sort | glycemic control in patients with diabetes on peritoneal dialysis from glucose sparing approach to glucose monitoring |
| topic | diabetes mellitus peritoneal dialysis icodextrin continuous glucose monitoring |
| url | https://www.mdpi.com/2075-1729/15/5/798 |
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