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Risk of hypoglycemia is increased by failure of kidney gluconeogenesis, impaired insulin clearance by the kidney, defective insulin degradation due to uremia, increased erythrocyte glucose uptake during hemodialysis, impaired counterregulatory hormone responses (cortisol, growth hormone), nutritional deprivation, and variability of exposure to oral antihyperglycemic agents and exogenous insulin. Patients with end-stage kidney disease frequently experience wide glycemic excursions, with common occurrences of both hypoglycemia and hyperglycemia. Assessment of glycemia by glycated hemoglobin (HbA1c) is hampered by a variety of CKD-associated conditions that can bias the measure either to the low or high range. Alternative glycemic biomarkers, such as glycated albumin or fructosamine, are not fully validated. Therefore, HbA1c remains the preferred glycemic biomarker despite its limitations. Based on observational data for associations with mortality and risks of hypoglycemia with intensive glycemic control regimens in advanced CKD, an HbA1c range of 7% to 8% appears to be the most favorable. Emerging data on the use of continuous glucose monitoring in this population suggest promise for more precise monitoring and treatment adjustments to permit fine-tuning of glycemic management in patients with diabetes and advanced CKD.<\/jats:p>","DOI":"10.1210\/endrev\/bnaa017","type":"journal-article","created":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T17:00:18Z","timestamp":1590512418000},"page":"756-774","source":"Crossref","is-referenced-by-count":193,"title":["Glycemic Monitoring and Management in Advanced Chronic Kidney Disease"],"prefix":"10.1210","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-3225","authenticated-orcid":false,"given":"Rodolfo J","family":"Galindo","sequence":"first","affiliation":[{"name":"Emory University School of Medicine, Division of Endocrinology, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy W","family":"Beck","sequence":"additional","affiliation":[{"name":"Jaeb Center for Health Research, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria F","family":"Scioscia","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine, Division of Endocrinology, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo E","family":"Umpierrez","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine, Division of Endocrinology, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine R","family":"Tuttle","sequence":"additional","affiliation":[{"name":"University of Washington, Division of Nephrology, Kidney Research Institute, and Institute of Translational Health Sciences, Seattle, Washington"},{"name":"Providence Medical Research Center, Providence Health Care, Spokane, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2020,5,26]]},"reference":[{"issue":"9131","key":"2021121111105894300_CIT0001","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/S0140-6736(98)07019-6","article-title":"Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). 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