From the Guidelines
It is strongly advised against placing a Continuous Glucose Monitoring (CGM) sensor on an arm with an arteriovenous (AV) fistula due to the risk of infection, interference with dialysis procedures, altered blood flow, and limited insertion sites. The primary reasons for this recommendation are:
- Risk of infection: The fistula site needs to be kept clean and protected to prevent infections that could compromise dialysis access, as highlighted in a study published in Diabetologia in 2024 1.
- Interference with dialysis procedures: Regular needle insertions for dialysis could disrupt the CGM sensor or its readings.
- Altered blood flow: The fistula changes blood flow in that arm, which might affect glucose readings, and a study suggested that a MARD of <15% can still be clinically beneficial for guiding diabetes management 1.
- Limited insertion sites: Preserving the fistula arm for dialysis access is crucial, so it's better to use other areas for CGM placement. Instead, consider placing the CGM sensor on the abdomen, upper buttocks, back of the upper arm without the fistula, or other FDA-approved sites as recommended by the specific CGM manufacturer, taking into account the importance of considering both ideal and practical accuracy levels when using CGMs in this specific population 1. Always consult with your healthcare provider for personalized advice, as they can take into account your individual medical situation and the specific CGM system you're using.
From the Research
Placement of Continuous Glucose Monitoring (CGM) Sensor
- The placement of a CGM sensor on an arm with an arteriovenous (AV) fistula is not directly addressed in the provided studies.
- However, studies have compared the accuracy of CGM sensors placed on the upper arm and abdomen in adults with type 1 diabetes, finding no significant difference in accuracy between the two sites 2, 3.
- One study found that the accuracy of a CGM sensor placed on the arm was not significantly different from the accuracy of sensors placed on the abdomen and gluteus in pediatric subjects with type 1 diabetes 3.
- There is no evidence to suggest that the presence of an AV fistula would affect the accuracy or safety of a CGM sensor placed on the arm.
- It is essential to consider the individual's specific medical condition and consult with a healthcare professional before placing a CGM sensor on an arm with an AV fistula.
Considerations for CGM Sensor Placement
- CGM sensors can be placed on various sites, including the abdomen, gluteus, and arm, with varying degrees of accuracy and comfort 2, 3, 4.
- The choice of placement site may depend on individual preferences, lifestyle, and medical conditions.
- It is crucial to follow the manufacturer's guidelines and healthcare professional's recommendations for CGM sensor placement and use.
Safety and Adverse Events
- Studies have reported minor local adverse events, such as hypersensitivity, itching, and pain, associated with CGM sensor insertion 5.
- There is no evidence to suggest that the presence of an AV fistula would increase the risk of adverse events associated with CGM sensor placement.
- It is essential to monitor for any adverse events and adjust the placement site or sensor as needed to minimize risks.