Continuous glucose monitoring to assess glycemic control in the first 6 weeks after pancreas transplantation

Abstract

Background: Current therapy for Type 1 diabetes (T1D) is characterized by significant glucose variability (GV). Pancreas transplantation (PT) is performed in certain T1D patients with and without end-stage renal disease. To date, GV has been examined to a limited extent after PT. Methods:We investigated GV using continuous glucose monitoring (CGM) 3-6 weeks after PT. Results: Eleven patients had simultaneous kidney pancreas transplantation (SPK),nine pancreas after kidney (PAK), and six pancreas transplantation alone (PTA). Mean CGM showed no difference between SPK, 126.5 ± 13.9, PAK 119.9 ± 12.8, and PTA 131.1 ± 29 mg/dL (P value .6). Percentage of time in range (TIR, 70-180 mg/dL) was 92% for SPK, 93.4% in PAK, and 88.5% in PTA with only 0.3%, 1.5%, and 0.3% of time <70 mg/dL. Percentage >180 mg/dL was 7.9% for SPK, 4.9% PAK, and 11% in PTA. Other measures of GV were similar in the three cohorts. In six patients, CGM was performed before and after PT and improved significantly. GV was also better compared with a matched cohort of T1D patients. Conclusions: All 3 types of PT resulted in excellent glucose control 3-6 weeks postprocedure. CGM outcomes represent an important objective outcome after PT. K E Y W O R D S continuous glucose monitor, glycemic variability, hyperglycemia and hypoglycemia, pancreas transplantation, Type 1 diabetes S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Dadlani V, Kaur RJ, Stegall M, et al. Continuous glucose monitoring to assess glycemic control in the first 6 weeks after pancreas transplantation. Clin

Do pretransplant C‐peptide levels predict outcomes following simultaneous pancreas‐kidney transplantation? A matched case‐control study

“…Concurrently, data on SPKT outcomes in patients with T2DM began appearing in the annual IPTR reports starting in the mid‐1990s 6 . In these reports, the annual proportion of SPKT recipients identified as having T2DM increased from 4% prior to 2002 to 8% from 2002 to 2011 and is currently at 21% for SPKT recipients 3–6,42 . Common characteristics of patients reported as having T2DM compared to T1DM included older age (both at time of onset of DM and also at the time of transplant), absence of autoantibodies and ketoacidosis, treatment with oral agents at the time of initial DM diagnosis, higher BMI, more frequently male and non‐Caucasian, presence of Cp, and shorter duration of DM.…”

“…[Cp] levels, later age of onset and shorter duration of DM, not insulinrequiring at time of diagnosis, absence of autoimmune markers, and ketoacidosis) has increased from 6% to 18% commensurate with an increase in the annual proportion of African American (AA) SPKT recipients from 10% to 30%. [3][4][5][6] For SPKT recipients reported as having type 1 DM (T1DM), approximately 60% are non-Hispanic Caucasian and 24% are AA. Conversely, for SPKT recipients reported as having T2DM, 24% are Caucasian, 42% are AA and 22% are Hispanic.…”

“…Unfortunately, previous reports of SPKT in T2DM (usually defined by detection of pretransplant Cp levels) compared to SPKT in T1DM have been limited to either small single center cohorts or large registry experiences, none of which had well-matched control groups. [3][4][5][6][9][10][11][12][13][14][15][16][17][18][19][20][21] The purpose of this study was to review retrospectively our single center experience with SPKT in the modern era using a case-matched design in patients identified as having either a pretransplant Cp level ≥2.0 ng/mL (Cp+ group) or a pretransplant Cp level < .5 ng/mL (Cp-group).…”

“…In the past 2 decades, the annual proportion of SPKT recipients with a type 2 DM (T2DM) phenotype (detectable pretransplant C‐peptide [Cp] levels, later age of onset and shorter duration of DM, not insulin‐requiring at time of diagnosis, absence of autoimmune markers, and ketoacidosis) has increased from 6% to 18% commensurate with an increase in the annual proportion of African American (AA) SPKT recipients from 10% to 30% 3–6 . For SPKT recipients reported as having type 1 DM (T1DM), approximately 60% are non‐Hispanic Caucasian and 24% are AA.…”

“…A functioning pancreas transplant mitigates glycemic variability and eliminates the daily burden of DM by freeing the patient both from the need to monitor serum glucose and administer exogenous insulin 4 . Importantly, a successful pancreas transplant is currently the single most effective method of achieving sustainable and excellent glucose control and renders the patient “ex‐diabetic.” 4,5 However, the “trade‐off” of pancreas transplantation includes surgical complications of the procedure as well as the need for and side effects associated with chronic immunosuppression.…”