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The Relationship Between Glycemic Control and Morbidity and Mortality for Diabetics on Dialysis

This study was conducted to determine the association between glycemic control and clinical outcomes of diabetic patients maintained on chronic dialysis. The study group consisted of 226 diabetics (60 Type I and 166 Type II) classified as having either good glycemic control (>5 0% of blood glucose determinations within 3.3-11.1 mmol/L) or poor glycemic control (<50% of blood glucose measurements >3.3 and <11.1 mmol/L). The following variables were analyzed in each group: demographics; vascular and diabetic complications; laboratory values; and patient survival. In comparison to diabetics with poor control (Type I, n=44; Type II, n=57), those with good control, either Type I (n=16), or Type II (n=109), were dialyzed for longer periods and had shorter hospitalizations, lower prevalence rates of myocardial infarctions, congestive heart failure, orthostatic hypotension, gastroparesis and enteropathy, and higher mean serum albumin. Mean patient survival by life-table analysis was as follows: Type I diabetics, good control 128.9 + 8.1 months, poor control 29.5 + 5.0 months, p=0.0014. Type II diabetics, good control 56.9 + 6.8 months, poor control 22.8 + 4.6 months, p<0.0001. Good glycemic control during the first 6 months of dialysis predicted long-term survival for Type II but not for Type I diabetics. Poor glycemic control is associated with increased morbidity from vascular and diabetic complications, malnutrition, and shortened survival in diabetics on chronic dialysis. Although further studies are needed to determine whether poor glycemic control causes shortened survival or merely reflects comorbid conditions shortening survival, good glycemic control may constitute a Worthwhile therapeutic goal for diabetics on dialysis.