| [ Summary ] |
"Treatment Guide for Diabetes 2018-2019" was published by the Japan Diabetes Society; it concerns diabetes diabetes in the general population. "Evidence-based Clinical Practice Guideline for CKD 2018" was published by the Japanese Society of Nephrology; it includes guidelines for non-dialysis patients with diabetic kidney disease. There is a treatment guide, "Best Practice for Diabetic Patients on Hemodialysis 2012", which was published by the Japanese Society for Dialysis Therapy for patients undergoing hemodialysis. Predialysis casual plasma glucose and glycated albumin (GA) levels are recommended as indicators for glycemic control, and hemoglobin A1c (HbA1c) level might be used only as a reference because HbA1c level decreases in the presence of anemia or erythropoiesis-stimulating agents (ESAs) and may not accurately represent glycemic control in hemodialysis patients. Tentative targets for glycemic control recommended for hemodialysis patients are predialysis casual plasma glucose levels (or 2-h postprandial plasma glucose levels) <180-200 mg/dL and GA levels <20.0 %. GA levels <24.0 % are suggested for hemodialysis patients with a history of cardiovascular events and who have hypoglycemic episodes. Further studies are required to definitively determine target values. In glycemic control, multiple indicators, including predialysis casual plasma glucose and GA levels, should be comprehensively evaluated to reduce the risk of hypoglycemia and improve the prognosis of patients. |