Management of Diabetes in Patients on Hemodialysis

Abstract

Managing diabetes in hemodialysis (HD) patients can be a daunting task. The various mechanisms at play in such patients may result in wide fluctuations in glucose levels. The interplay between uremia and HD employ antagonizing forces on insulin secretion, metabolism, action and tissue sensitivity, hence the wide variation in glycemic level. Management is further complicated by the absence of an ideal monitoring tool to evaluate glycemic control in diabetics on HD. The use of HbA1c in uremic patients has been questioned in the last decade.1 Moreover, the target HbA1c in this population has not been established.2 Despite, diabetes being the most common cause of end stage renal disease in the United States,3 there is still controversy on how aggressive diabetes should be managed in HD patients.4–8;