Application and management of continuous glucose monitoring in diabetic kidney disease

Diabetic kidney disease(DKD)is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease(ESKD).Wide glycemic var-iations,such as hypoglycemia and hyperglycemia,are broadly found in diabetic patients with DKD and especially ESKD,as a result of impaired renal metabolism.It is essential to monitor glycemia for effective management of DKD.Hemoglobin A1c(HbA1c)has long been considered as the gold standard for monitoring glycemia for>3 months.However,assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction.Continuous glucose monitoring(CGM)has provided new insights on glycemic assessment and management.CGM directly measures glucose level in interstitial fluid,reports real-time or retrospective glucose concentration,and provides multiple glycemic metrics.It avoids the pitfalls of HbA1c in some contexts,and may serve as a precise alternative to estimation of mean glucose and glycemic variability.Emerging studies have demonstrated the merits of CGM for precise monitoring,which allows fine-tuning of glycemic management in diabetic patients.Therefore,CGM technology has the potential for better glycemic monitoring in DKD patients.More research is needed to explore its application and management in different stages of DKD,including hemodialysis,peritoneal dialysis and kidney transplantation.

Sustained dialysis with misplaced peritoneal dialysis catheter outside peritoneum:A case report

BACKGROUND In patients undergoing peritoneal dialysis(PD),catheter dysfunction is a common complication.A misplaced catheter is one of the reasons contributing to its dysfunction.The present study aimed to describe a case of misplaced PD catheter with an unusual location of the catheter tip.CASE SUMMARY A 61-year-old man undergoing PD for 4 years was investigated for progressive nausea and fatigue of 3 mo.Dialysis adequacy studies indicated inefficient dialysis.Imaging discovered that the PD catheter tip was mispositioned in the pelvic cavity with its tip outside the peritoneal cavity.Despite the dialysate accumulating outside the peritoneal cavity,the patient had not developed perineal or scrotal edema.The patient had experienced a sustainable prolonged dialysis efficacy in this case until the renal function deteriorated further in view of the poor dialysis outcome and worsening health condition.The patient was subsequently transitioned to hemodialysis.CONCLUSION Proper placement of the catheter in the peritoneal cavity should always be confirmed and rechecked when necessary in patients undergoing PD to ensure dialytic adequacy.

Link between periodontitis and diabetic retinopathy:Inflammatory pathways and clinical implications

The bidirectional relationship between periodontitis and type 2 diabetes mellitus has been well-established.However,the underlying molecular mechanisms remain unclear.Diabetic retinopathy(DR)is an important complication of diabetes,but there are few studies on the relationship between DR and periodontitis,especially on the intrinsic inflammatory pathway mechanism.This article reviews the latest clinical data on how diabetes promotes susceptibility to periodontitis from the epidemiological and molecular perspectives,with a special focus on the key roles of systemic inflammation and endothelial dysfunction in the interplay between DR and periodontitis.Comprehension of the intertwined pathogenesis of DR and periodontitis can better guide the development of comprehensive management strategies for glycemic control and periodontal health,with the aim of mitigating the progression of DR and enhancing overall well-being.