In patients with type 2 diabetes (T2D) undergoing hemodialysis (HD), glycemic control is challenging, and glycated hemoglobin (HbA1c) is often unreliable due to altered red blood cell turnover, anemia, and treatments such as erythropoiesis-stimulating agents. Continuous glucose monitoring (CGM) provides additional metrics—such as time in range (TIR), time below range (TBR), and glycemic variability—that may better reflect glucose control in this population. This study aimed to assess the usefulness of 14-day CGM data compared to HbA1c in evaluating glycemic control in T2D patients on HD.

This is a prospective and multicenter study. Patients included were of > 18 years, DM2, and hemodialysis patients. We assessed glycemic control of diabetic hemodialysis patient over 14 days with the CGM freestyle 1 comparing to HbA1c.

Forty-one patients were included. While 68% had HbA1c < 8%, only 21% met the CGM targets ( P < 0.005). Mean glucose levels were significantly lower on dialysis days (−13 mg/dl, P < 0.0001), without an increase in hypoglycemic episodes. Discrepancies between HbA1c and CGM metrics were associated with diabetes-related nephropathy and longer duration of HD.

HbA1c alone may substantially underestimate glycemic burden in patients on hemodialysis. CGM provides a more accurate assessment of glucose control and reveals undetected hypo- and hyperglucose levels. Incorporating CGM into routine care may improve diabetes management and therapeutic decision-making in this high-risk population.