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End Stage Kidney DiseaseNCT05741489

Continuous Glucose Monitoring in Patients With End-Stage Kidney Disease and Burnt-Out Diabetes

A study testing Continuous glucose monitoring (CGM) in people with End Stage Kidney Disease, run by Emory University at 4 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Twenty participants with end stage kidney disease (ESKD) and burnt-out diabetes, and 20 non-diabetic participants with ESKD will wear a continuous glucose monitoring (CGM) device for 10 days to see if the use of CGM is a better tool to assess glycemic control than glycosylated hemoglobin (HbA1c) in patients with ESKD… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
End Stage Kidney Disease
What is being tested?
Continuous glucose monitoring (CGM)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
4 sitesUnited States
Study dates
10 Aug 2022to 9 Mar 2023
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Dialysis treatment for more than 3 months
  • HbA1c less than 6.5% at the first clinic visit
  • Willing to wear a CGM for 10 days

Who cannot join

  • Have used insulin or any diabetes treatment during the last 3 months
  • Be pregnant or plan to become pregnant during the study
  • Known allergy to medical-grade adhesives
  • Taking acetaminophen (more than 1 gram every six hours) or hydroxyurea (may interfere with sensor membrane)
  • Current or anticipated use of stress steroid doses (prednisone </= 5 mg or its equivalent is allowed)

Trial locations and contacts

4 sites in 1 country.

United States4 sites
  • Grady Memorial Hospital

    Atlanta, Georgia, 30303

  • Emory Dialysis at Northside

    Atlanta, Georgia, 30318

  • Emory Dialysis at Greenbriar

    Atlanta, Georgia, 30331

  • Emory Dialysis at Candler

    Decatur, Georgia, 30034

Other trials in United States

About this study

Twenty participants with end stage kidney disease (ESKD) and burnt-out diabetes, and 20 non-diabetic participants with ESKD will wear a continuous glucose monitoring (CGM) device for 10 days to see if the use of CGM is a better tool to assess glycemic control than glycosylated hemoglobin (HbA1c) in patients with ESKD on dialysis.

Read the detailed description

More than 37 million adults, or 14.7% of all Americans aged 18 and older, are living with diabetes. Controlling hyperglycemia is foundational to diabetes management and is necessary to reduce the risks of chronic diabetes complications and death. Diabetic nephropathy accounts for great morbidity, as diabetes is the number one cause of chronic kidney disease (CKD) and end stage kidney disease (ESKD) in the United States. It is estimated that diabetes affects up to 40% of patients with ESKD.

Assessment of glucose control in patients with advanced CKD/ESKD is complex due to changes in glucose homeostasis, potential effects on assays of glycemia, and altered pharmacokinetics of diabetes medications. Glycosylated hemoglobin (HbA1c) has been the gold standard to assess glycemic control in patients with diabetes. HbA1c reflects the average glycemic value over approximately 3 months. Although HbA1c is associated with chronic complications of diabetes in patients with normal kidney function, its predictive value is uncertain in patients with ESKD or estimated glomerular filtration rate (eGFR) <30 ml/min. HbA1c reliability in ESKD is reduced because of anemia, shortened erythrocyte lifespan, protein-energy wasting, and malnutrition-inflammation cachexia syndrome, among others. To overcome the limitations of HbA1c, alternative methods to assess long-term glycemic control have been proposed including fructosamine and glycated albumin. Fructosamine measures ketoamines formed by non-enzymatic glycation of serum proteins. It is a useful index for glycemic control over the prior 2 to 4 weeks, and some studies have reported that fructosamine more accurately reflects blood glucose control than HbA1c in anemic patients with ESKD on dialysis. However, there may be falsely low readings in the presence of hypoalbuminemia due to protein-energy wasting and in peritoneal dialysis due to dialysate protein loss. Glycated albumin is a useful marker reflecting glycemic control over the prior 2 to 4 weeks. In patients with ESKD, glycated albumin more rapidly reflects the status of blood glucose control than HbA1c. Like fructosamine, there is potential for falsely low readings in patients with peritoneal dialysis with dialysate protein losses and hypoalbuminemia.

Continuous glucose monitoring (CGM) technology in the outpatient setting has transformed glucose monitoring for diabetes self-management, providing more comprehensive glycemic control data than intermittent point-of-care capillary blood glucose monitoring and HbA1c.

Once progressed to ESKD, up to one fourth of patients experience resolution of their hyperglycemia, as defined by an HbA1c level of less than 6.5%, and consequently are no longer on antidiabetic agents and insulin. This phenomenon is known as "burnt-out diabetes" which is likely due to various underlying factors, including but not limited to, malnutrition, reduced clearance and degradation of insulin, decreased kidney gluconeogenesis, and accumulation of uremic toxins. These patients are likely at a greater risk of morbidity and mortality and an increased risk of hypoglycemic episodes. There is a need for further research in patients with ESKD to establish what is the most appropriate tool to assess glycemic control in those with 'burnt-out diabetes'.

This study will use CGM to measure patients' glucose with real-time levels as opposed to relying on surrogate markers like HbA1c. These results can give insight into the reality of glycemic control in these patients and can impact the best monitoring and treatment for patients with burnt-out diabetes. It is not known if patients with burnt-out diabetes have complete normoglycemia or if they may have episodes of (untreated) hyperglycemia, which may be associated with poor outcomes. The researchers of this study will compare glycemic control by CGM in patients with burnt-out diabetes and non-diabetic patients with ESKD.

Being tested
Continuous glucose monitoring (CGM)
Keywords
Burnt-out diabetes, Dialysis, End stage renal disease, Kidney failure
Medical subject headings
Kidney Failure, Chronic, Renal Insufficiency

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Continuous glucose monitoring (CGM)Device

    Also called Dexcom G6 CGM

    The Dexcom G6 CGM system is a compact, light-weight glucose testing device that measures glucose every 5 minutes. Participants will wear the CGM with the display off for 10 days while continuing their routine dialysis sessions.

Study groups in NCT05741489
Study groupRoleWhat they receive
ESKD with Burnt-out DiabetesExperimentalParticipants with ESKD and burnt-out diabetes wearing a CGM for 10 days.
Receives: Device: Continuous glucose monitoring (CGM)
ESKD without DiabetesExperimentalNon-diabetic participants with ESKD wearing a CGM for 10 days.
Receives: Device: Continuous glucose monitoring (CGM)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percent of Time in Range (TIR) Between 70-180 mg/dL

    Glycemic control is measured as the percentage of time that blood glucose levels are in the range of 70 and 180 mg/dL, as measured by CGM.

    Measured: Up to 10 days

  2. Percent of Time Above Range (Blood Glucose >180 mg/dL)

    Glycemic control is assessed a the percentage of time in hyperglycemia, defined as the time above range (TAR) with blood glucose measurements >180 mg/dL, as measured by CGM.

    Measured: Up to 10 days

  3. Percent of Time Above Range (Blood Glucose >250 mg/dL)

    Glycemic control is assessed a the percentage of time in hyperglycemia, defined as the time above range (TAR) with blood glucose measurements >250 mg/dL, as measured by CGM.

    Measured: Up to 10 days

  4. Duration of Hyperglycemia (Blood Glucose >180 mg/dL)

    Glycemic control is assessed as the duration of hyperglycemia with blood glucose measurements >180 mg/dL, as measured by CGM for hyperglycemia time periods of greater than 15 minutes.

    Measured: Up to 10 days

  5. Duration of Hyperglycemia (Blood Glucose >250 mg/dL)

    Glycemic control is assessed as the duration of hyperglycemia with blood glucose measurements >250 mg/dL, as measured by CGM for hyperglycemia time periods of greater than 15 minutes.

    Measured: Up to 10 days

  6. Number of Participants With Hyperglycemic Episodes With Blood Glucose >250 mg/dL

    The number of participants experiencing hyperglycemia with blood glucose levels > 250 mg/dL as measured by CGM.

    Measured: Up to Day 10

  7. Percent of Time Below Range (Blood Glucose <70 mg/dL)

    Glycemic control is assessed a the percentage of time in hypoglycemia, defined as the time below range (TBR) with blood glucose measurements < 70 mg/dL, as measured by CGM.

    Measured: Up to 10 days

  8. Percent of Time Below Range (Blood Glucose <54 mg/dL)

    Glycemic control is assessed a the percentage of time in severe hypoglycemia, defined as the time below range (TBR) with blood glucose measurements < 54 mg/dL, as measured by CGM.

    Measured: Up to 10 days

  9. Hypoglycemia Event Rate

    Hypoglycemia is defined as blood glucose < 70 mg/dL and is assessed by Dexcom G6 CGM. The hypoglycemic event rate is defined as the number of hypoglycemic events per patient per day.

    Measured: Up to Day 10

  10. Number of Participants With Hypoglycemic Episodes

    The number of participants experiencing hypoglycemia with blood glucose levels < 70 mg/dL as measured by CGM.

    Measured: Up to Day 10

  11. Nocturnal Hypoglycemia Event Rate

    Hypoglycemia is defined as blood glucose < 70 mg/dL and is assessed by Dexcom G6 CGM. A nocturnal hypoglycemia episode is defined as an episode occurring during the time interval of 10:00 Post Meridiem (PM) to 6:00 Ante Meridiem (AM). The hypoglycemic event rate is defined as the number of hypoglycemic events per patient per day.

    Measured: Up to Day 10

  12. Number of Participants With Nocturnal Hypoglycemic Episodes

    The number of participants experiencing nocturnal hypoglycemia with blood glucose levels < 70 mg/dL as measured by CGM. A nocturnal hypoglycemia episode is defined as an episode occurring during the time interval of 10:00 Post Meridiem (PM) to 6:00 Ante Meridiem (AM).

    Measured: Up to Day 10

Secondary outcomes (2)
  1. Mean Daily Blood Glucose Concentration

    Glycemic control is assessed as mean daily glucose concentration, measured by Dexcom G6 CGM.

    Measured: Up to Day 10

  2. Glycemic Variability Calculated by Mean Amplitude of Glycemic Excursions (MAGE)

    Mean amplitude of glycemic excursions (MAGE) is the parameter for assessing glycemic variability and is calculated based on the arithmetic mean of differences between consecutive peaks and nadirs of differences greater than one standard deviation (SD) of mean glucose values. It is designated to assess major glucose swings and exclude minor ones.

    Measured: Up to 10 Days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Feb 2023
  2. Study start10 Aug 2022
  3. Primary completion9 Mar 2023
  4. Study completion9 Mar 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05741489
Sponsor's protocol ID
STUDY00004617
Status last verified
Feb 2024
First submitted
14 Feb 2023
Last updated
5 Apr 2024
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Kaminski CY, Galindo RJ, Navarrete JE, Zabala Z, Moazzami B, Gerges A, McCoy RG, Fayfman M, Vellanki P, Idrees T, Peng L, Umpierrez GE. Assessment of Glycemic Control by Continuous Glucose Monitoring, Hemoglobin A1c, Fructosamine, and Glycated Albumin in Patients With End-Stage Kidney Disease and Burnt-Out Diabetes. Diabetes Care. 2024 Feb 1;47(2):267-271. doi: 10.2337/dc23-1276.

    PubMed 38085705

Questions about this trial

What is this clinical trial studying?

A study testing Continuous glucose monitoring (CGM) in people with End Stage Kidney Disease, run by Emory University at 4 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 5 Apr 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percent of Time in Range (TIR) Between 70-180 mg/dL (time frame: Up to 10 days). The study lists 12 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05741489, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Apr 2024.

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