Continuous Glucose Monitoring in Subjects After Simultaneous Pancreas-kidney and Kidney-alone Transplantation

Overview

Journal Diabetes Technol Ther

Specialties Endocrinology
Pharmacology

Date 2010 Apr 15

PMID 20388044

Citations 12

Authors

Luisa M Rodriguez

Richard J Knight

Rubina A Heptulla

Affiliations

Soon will be listed here.

Abstract

Background: Simultaneous pancreas-kidney (SPK) transplantation is an important replacement therapy for individuals with diabetes and end-stage renal disease. Kidney-alone (KA) transplantation is associated with a high incidence of post-transplant diabetes.

Methods: This was a cross-sectional study. We studied 48-h glucose concentrations in eight subjects with type 1 diabetes mellitus after SPK transplantation, six subjects post-KA transplantation, and nine healthy controls using the CGMS (Medtronic Minimed, Northridge, CA) continuous glucose monitoring system.

Results: The 48-h mean glucose concentration was 101 +/- 7 mg/dL in the SPK subjects, 105 +/- 12 mg/dL in the KA subjects, and 99 +/- 7 mg/dL in the healthy controls. The glycemic excursions were higher in the KA group compared to the SPK cohort and healthy controls (P < 0.0001). No differences in the incidence of hypoglycemia were detected among the three groups. Significant postprandial hyperglycemia was uncovered in four of the six KA subjects.

Conclusions: SPK transplantation is very effective at normalizing glycemic excursions. Unsuspected hyperglycemia was identified in the KA group. The CGMS was a useful ambulatory tool to study glucose profiles in the post-transplant period and may help uncover hyperglycemia undetected by routine laboratory testing.

Citing Articles

Analysis of Rejection, Infection and Surgical Outcomes in Type I Versus Type II Diabetic Recipients After Simultaneous Pancreas-Kidney Transplantation.

Martinez E, Pham P, Wang J, Stalter L, Welch B, Leverson G Transpl Int. 2024; 37:13087.

PMID: 39364120 PMC: 11446817. DOI: 10.3389/ti.2024.13087.

Perioperative glucose monitoring with continuous glucose monitors identifies risk factors for post-transplant diabetes mellitus in kidney transplant recipients.

Shin J, Jo E, Woo H, Cho A, Ko M, Kim S Sci Rep. 2024; 14(1):21240.

PMID: 39261619 PMC: 11390710. DOI: 10.1038/s41598-024-72025-7.

Effects of simultaneous pancreas and kidney transplantation in Japanese individuals with type 1 diabetes and end-stage kidney disease.

Mori T, Nyumura I, Hanai K, Shinozaki T, Babazono T Diabetol Int. 2024; 15(2):278-289.

PMID: 38524933 PMC: 10959910. DOI: 10.1007/s13340-024-00691-z.

Continuous Glucose Monitoring-Guided Insulin Administration in Long-Term Care Facilities: A Randomized Clinical Trial.

Idrees T, Castro-Revoredo I, Oh H, Gavaller M, Zabala Z, Moreno E J Am Med Dir Assoc. 2024; 25(5):884-888.

PMID: 38460943 PMC: 11283256. DOI: 10.1016/j.jamda.2024.01.031.

Continuous Glucose Monitoring in Patients Following Simultaneous Pancreas-Kidney Transplantation: Time in Range and Glucose Variability.

Dmitriev I, Severina A, Zhuravel N, Yevloyeva M, Salimkhanov R, Shchelykalina S Diagnostics (Basel). 2023; 13(9).

PMID: 37174997 PMC: 10177867. DOI: 10.3390/diagnostics13091606.

References

Paty B, Lanz K, Kendall D, Sutherland D, Robertson R . Restored hypoglycemic counterregulation is stable in successful pancreas transplant recipients for up to 19 years after transplantation. Transplantation. 2001; 72(6):1103-7. DOI: 10.1097/00007890-200109270-00021. View

Rodrigo E, Fernandez-Fresnedo G, Valero R, Ruiz J, Pinera C, Palomar R . New-onset diabetes after kidney transplantation: risk factors. J Am Soc Nephrol. 2006; 17(12 Suppl 3):S291-5. DOI: 10.1681/ASN.2006080929. View

Sollinger H, Ploeg R, Eckhoff D, Stegall M, Isaacs R, Pirsch J . Two hundred consecutive simultaneous pancreas-kidney transplants with bladder drainage. Surgery. 1993; 114(4):736-43; discussion 743-4. View

Stratta R, Shokouh-Amiri M, Egidi M, Grewal H, Kizilisik A, Nezakatgoo N . A prospective comparison of simultaneous kidney-pancreas transplantation with systemic-enteric versus portal-enteric drainage. Ann Surg. 2001; 233(6):740-51. PMC: 1421316. DOI: 10.1097/00000658-200106000-00003. View

Kleinbaum J, Shamoon H . Impaired counterregulation of hypoglycemia in insulin-dependent diabetes mellitus. Diabetes. 1983; 32(6):493-8. DOI: 10.2337/diab.32.6.493. View

GARVIN P, Carney K, Aridge D . Evolution of synchronous renal and pancreatic transplantation. Am J Surg. 1989; 158(6):625-8; discussion 628-9. DOI: 10.1016/0002-9610(89)90209-2. View

Stratta R, Taylor R, Ozaki C, Bynon J, Miller S, Knight T . A comparative analysis of results and morbidity in type I diabetics undergoing preemptive versus postdialysis combined pancreas-kidney transplantation. Transplantation. 1993; 55(5):1097-103. DOI: 10.1097/00007890-199305000-00031. View

Hjelmesaeth J, Hartmann A, Leivestad T, Holdaas H, Sagedal S, Olstad M . The impact of early-diagnosed new-onset post-transplantation diabetes mellitus on survival and major cardiac events. Kidney Int. 2006; 69(3):588-95. DOI: 10.1038/sj.ki.5000116. View

Redmon J, Teuscher A, Robertson R . Hypoglycemia after pancreas transplantation. Diabetes Care. 1998; 21(11):1944-50. DOI: 10.2337/diacare.21.11.1944. View

10.

. Postprandial blood glucose. American Diabetes Association. Diabetes Care. 2001; 24(4):775-8. DOI: 10.2337/diacare.24.4.775. View

11.

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

12.

Bergenstal R, Polonsky K, Pons G, Jaspan J, Rubenstein A . Lack of glucagon response to hypoglycemia in type I diabetics after long-term optimal therapy with a continuous subcutaneous insulin infusion pump. Diabetes. 1983; 32(5):398-402. DOI: 10.2337/diab.32.5.398. View

13.

Mastrototaro J . The MiniMed Continuous Glucose Monitoring System (CGMS). J Pediatr Endocrinol Metab. 2000; 12 Suppl 3:751-8. View

14.

Battezzati A, Luzi L, Perseghin G, Bianchi E, Spotti D, Secchi A . Persistence of counter-regulatory abnormalities in insulin-dependent diabetes mellitus after pancreas transplantation. Eur J Clin Invest. 1994; 24(11):751-8. DOI: 10.1111/j.1365-2362.1994.tb01072.x. View

15.

Kessler L, Passemard R, Oberholzer J, Benhamou P, Bucher P, Toso C . Reduction of blood glucose variability in type 1 diabetic patients treated by pancreatic islet transplantation: interest of continuous glucose monitoring. Diabetes Care. 2002; 25(12):2256-62. DOI: 10.2337/diacare.25.12.2256. View

16.

Luzi L, Battezzati A, Perseghin G, Bianchi E, Vergani S, Secchi A . Lack of feedback inhibition of insulin secretion in denervated human pancreas. Diabetes. 1992; 41(12):1632-9. DOI: 10.2337/diab.41.12.1632. View

17.

Amiel S, Tamborlane W, Simonson D, Sherwin R . Defective glucose counterregulation after strict glycemic control of insulin-dependent diabetes mellitus. N Engl J Med. 1987; 316(22):1376-83. DOI: 10.1056/NEJM198705283162205. View

18.

Barrou Z, Seaquist E, Robertson R . Pancreas transplantation in diabetic humans normalizes hepatic glucose production during hypoglycemia. Diabetes. 1994; 43(5):661-6. DOI: 10.2337/diab.43.5.661. View

19.

Diem P, Redmon J, Abid M, Moran A, Sutherland D, Halter J . Glucagon, catecholamine and pancreatic polypeptide secretion in type I diabetic recipients of pancreas allografts. J Clin Invest. 1990; 86(6):2008-13. PMC: 329838. DOI: 10.1172/JCI114936. View

20.

Simonson D, Tamborlane W, DeFronzo R, Sherwin R . Intensive insulin therapy reduces counterregulatory hormone responses to hypoglycemia in patients with type I diabetes. Ann Intern Med. 1985; 103(2):184-90. DOI: 10.7326/0003-4819-103-2-184. View