Glucose tolerance in patients with and without type 2 diabetes mellitus during hemodialysis.

Abstract

AIMS\nThe disposal of a glucose bolus was studied to identify glucose metabolism in patients with and without type 2 diabetes mellitus (T2DM) during their regular hemodialysis (HD) treatment.\n\n\nMETHODS\nPlasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5g/kg dry weight). Glucose disposition and elimination rates were determined from kinetic analysis, and insulinogenic index was calculated. Insulin resistance (RHOMA) was determined by homeostatic model assessment (HOMA).\n\n\nRESULTS\n35 HD patients (14 with T2DM) distinguished by a higher age (median: 70 vs. 55 y, p<0.01) in T2DM patients were studied. Glucose kinetic data showed only small differences between patients with or without T2DM, but as RHOMA measured in all patients increased, a larger fraction of glucose was removed by the extracorporeal system (r=0.430, p=0.01). One hour after glucose bolus injection the glucose level was not different from that before HD also in patients with T2DM (p=0.115).\n\n\nCONCLUSIONS\nThe larger glucose amount recovered in dialysate in patients with increasing RHOMA indicates that impaired glucose disposal could be measured during HD using a non-invasive dialysis quantification approach without blood sampling. Glucose infusion during HD is safe also in patients with T2DM.