Researchers in Turkey studied over 5,000 patients on kidney dialysis who also have diabetes to understand how well they control their blood sugar and what health problems they develop. They found that patients with higher blood sugar levels (measured by a test called HbA1c) had more serious complications, including heart disease, eye problems, and foot problems. The study shows that better blood sugar control is important for dialysis patients, and doctors need to work harder to help these patients reach recommended targets. This research helps doctors understand what happens when blood sugar isn’t well-controlled in people whose kidneys don’t work properly.

The Quick Take

  • What they studied: How well diabetic patients on kidney dialysis control their blood sugar and what health problems develop based on their blood sugar levels
  • Who participated: 5,038 patients with diabetes who receive kidney dialysis treatment at 253 dialysis centers across Turkey. Average age was 64 years old, and 56% were male
  • Key finding: Patients with higher blood sugar levels had significantly more health problems including high blood pressure, heart disease, eye damage, and foot problems. Those with the worst blood sugar control had the most complications
  • What it means for you: If you have diabetes and kidney disease requiring dialysis, keeping your blood sugar well-controlled may help prevent serious complications like heart disease and vision loss. Talk to your doctor about your blood sugar targets and how to reach them

The Research Details

Researchers collected information from 16,043 dialysis patients at 253 treatment centers across Turkey. They selected 5,038 patients who had diabetes and reviewed their medical records, including blood sugar test results (HbA1c), blood pressure, medications, and any complications they had developed. The doctors recorded everything about each patient’s diabetes history and current health problems. They then organized patients into groups based on their blood sugar control levels to see if those with worse control had more health problems.

This study design allowed researchers to look at a very large group of real patients receiving actual treatment in Turkey, making the results more relevant to everyday medical practice. By comparing patients with different blood sugar levels, they could see patterns in who develops complications. This type of study is good for identifying problems that need attention but can’t prove that high blood sugar directly causes the complications.

The study included a large number of patients (over 5,000) from many different dialysis centers, which makes the findings more reliable and representative of the real world. Doctors at each center carefully reviewed and recorded patient information, which improves accuracy. However, because this was a snapshot study (not following patients over time), we can see that problems exist together but can’t be completely certain about cause and effect. The study was conducted in Turkey, so results may vary in other countries with different healthcare systems.

What the Results Show

The study found clear patterns: as patients’ blood sugar levels increased, their health problems increased too. Patients with poor blood sugar control had higher blood pressure readings compared to those with better control. The rate of heart disease was significantly higher in the group with the worst blood sugar control. Eye problems, including vision loss from diabetes, were much more common in patients with high blood sugar levels. Foot problems related to diabetes and even amputations (removal of toes or feet) occurred more frequently in patients with poor blood sugar control.

Patients with high blood sugar levels were more likely to be taking insulin injections, especially those on intensive or mixed insulin regimens. Older patients tended to have better blood sugar control than younger patients, which was unexpected. Patients with higher body weight had slightly higher blood sugar levels. Doctors recommended dietary changes more often for patients with poor blood sugar control, suggesting that diet management is an important part of treatment.

This study confirms what doctors already know from other research: better blood sugar control reduces complications in diabetic patients. However, this is one of the first large studies specifically looking at diabetic patients on dialysis in Turkey. The findings align with international guidelines that recommend specific blood sugar targets, though the study notes that many Turkish dialysis patients aren’t reaching these targets yet.

This study took a snapshot of patients at one point in time, so we can’t see how their health changed over months or years. We can see that high blood sugar and complications exist together, but we can’t prove that high blood sugar directly caused the complications. The study only included patients in Turkey, so results might be different in other countries. We don’t know if patients with better blood sugar control started that way or improved over time. Some important information about individual patients’ treatment plans may not have been recorded.

The Bottom Line

If you have diabetes and kidney disease requiring dialysis, work with your healthcare team to keep your blood sugar as close to target as possible (generally below 7-8% on the HbA1c test). This may involve taking medications as prescribed, following a diabetes-friendly diet, and regular monitoring. The evidence suggests this approach may help prevent serious complications. Confidence level: Moderate to High based on this and previous research.

This research is most important for people with diabetes who have kidney disease and receive dialysis treatment. It’s also relevant for their doctors and nurses who manage their care. Family members of dialysis patients should understand why blood sugar control matters. People with diabetes who still have some kidney function should pay attention as a warning about the importance of early blood sugar control. This doesn’t directly apply to people with diabetes who have normal kidney function or to people on dialysis without diabetes.

Improving blood sugar control is a long-term process. You may notice some benefits in blood pressure within weeks to months, but preventing serious complications like heart disease and vision loss takes consistent effort over years. Regular check-ups every 3-6 months help track progress.

Want to Apply This Research?

  • Log your HbA1c test results every 3 months and track your daily blood sugar readings if you test at home. Record your blood pressure at each dialysis session. Note any new symptoms like vision changes, foot pain, or chest discomfort to discuss with your doctor
  • Set a specific blood sugar target with your doctor and use the app to track progress toward that goal. Log your meals to identify patterns in what affects your blood sugar. Set reminders for taking diabetes medications at the same time each day. Track your weight weekly to monitor trends
  • Create a monthly dashboard showing your HbA1c trend, average blood pressure readings, and medication adherence. Share this data with your healthcare team at each visit. Set alerts if blood sugar readings go above or below your target range. Review quarterly progress and adjust strategies with your doctor as needed

This research describes patterns in how blood sugar control relates to complications in dialysis patients but does not provide personalized medical advice. If you have diabetes and kidney disease, work with your nephrologist (kidney doctor) and endocrinologist (diabetes specialist) to develop a treatment plan tailored to your specific situation. Do not change your medications or treatment without consulting your healthcare provider. This study was conducted in Turkey and results may vary based on individual factors and healthcare systems. Always discuss any concerns about your blood sugar control or complications with your medical team.