1400-P: Clinical Profiles Stratified by Glycation Gap in People with Type 2 Diabetes Undergoing Hemodialysis

Introduction and Objective: In people with type 2 diabetes undergoing hemodialysis (HD), HbA1c levels tend to be underestimated, resulting in a discrepancy between HbA1c and the CGM-derived glucose management indicator (GMI)—known as the glycation gap (GG). However, it remains unclear which patient characteristics are associated with GG values. Methods: We calculated the GMI from CGM data in 116 people with type 2 diabetes undergoing HD (80 males; mean age 61 years; HbA1c 6.5%; glycated albumin [GA] 21.1%). The GG was categorized into three groups: < -0.5%, -0.5% to 0.5%, and > 0.5%. Clinical characteristics were compared among these groups. Results: Compared with the GG -0.5% to 0.5% group (n = 40), the < -0.5% group (n = 61) had longer diabetes and HD durations, significantly lower RBC counts, required higher ESA doses, and had significantly lower HbA1c levels. Although GA, mean glucose, glycemic variability, TIR, and TAR did not differ between the groups, TBR was significantly lower in the < -0.5% group. In contrast, compared with the GG -0.5% to 0.5% group, the > 0.5% group (n = 15) had significantly higher BMI, HbA1c, GA, mean glucose levels, and had significantly lower TIR. Conclusion: In people with type 2 diabetes undergoing HD, GG was associated with distinct clinical phenotypes. A negative GG was linked to longer diabetes/HD duration and anemia-related factors, whereas a positive GG reflected poorer glycemic control and greater glycemic exposure. These findings suggest that GG may help interpret HbA1c values and optimize glycemic assessment in this population. Disclosure A. Hayashi: Speaker's Bureau; Ended; Abbott Japan Co., Ltd., Dexcom, Inc., Medtronic, Novo Nordisk, Roche Diabetes Care, Sanwa Kagaku Kenkyusho. S. Nagao: None. H. Miura: None. H. Sogabe: None. S. Tsuji: None. T. Miyatsuka: Advisory Panel; Current; Eli Lilly and Company. Speaker's Bureau; Current; Eli Lilly and Company. Advisory Panel; Current; Novo Nordisk. Speaker's Bureau; Current; Novo Nordisk, Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Sumitomo Pharma, Tanabe Pharma. Funding the Japan Society for the Promotion of Science (JSPS) KAKENHI (22K15674 and 25K10690)