Longin Niemczyk1, Daniel Schneditz2, Anna Wojtecka3, Katarzyna Szamotulska4, Jerzy Smoszna5, Stanisław Niemczyk6. 1. Dept. of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland. Electronic address: lniemczyk@wum.edu.pl. 2. Otto Loewi Research Center, Div. of Physiology, Medical University of Graz, Neue Stiftingtalstrasse 6/V, 8010 Graz, Austria. Electronic address: daniel.schneditz@medunigraz.at. 3. Dept. of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland. Electronic address: awojtecka@wim.mil.pl. 4. Dept. of Epidemiology and Biostatistics, National Research Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland. Electronic address: szamotul@imid.med.pl. 5. Dept. of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland. Electronic address: jsmoszna@wim.mil.pl. 6. Dept. of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland. Electronic address: sniemczyk@wim.mil.pl.
Abstract
AIMS: The 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. METHODS: Plasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5 g/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). RESULTS: 35 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). CONCLUSIONS: The 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.
AIMS: The 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. METHODS: Plasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5 g/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). RESULTS: 35 HDpatients (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). CONCLUSIONS: The 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.