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Continuous glucose monitoring system (CGMS) in kidney-transplanted children
Krisztina Pasti1, Attila J Szabo, Agnes Prokai
1First Department of Pediatrics and Nephrology, Research Laboratory of the Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.
Insights
New research on children post-kidney transplant reveals altered glucose levels in those with impaired glucose tolerance (IGT). Continuous glucose monitoring (CGM) helps identify these changes, crucial for managing transplant complications.
Area of Science:
- Nephrology
- Endocrinology
- Pediatric Research
Background:
- New-onset diabetes after transplantation (NODAT) and impaired glucose tolerance (IGT) are significant complications following transplantation.
- These conditions increase cardiovascular disease risk and negatively impact patient and graft survival.
- Early detection and management of dysglycemia are critical in post-transplant care.
Purpose of the Study:
- To investigate glycemic homeostasis in pediatric renal transplant recipients.
- To assess the utility of routine lab tests and continuous glucose monitoring systems (CGMS) for identifying dysglycemia.
- To explore the relationship between IGT, glucose variability, and time post-transplantation.
Main Methods:
- Study included 20 pediatric renal transplant recipients.
- Glycemic status assessed using routine laboratory tests and oral glucose tolerance tests (OGTT).
- Continuous glucose monitoring system (CGMS) used for detailed glucose profiling.
Main Results:
- 30% of patients had IGT, and 5% had NODAT.
- Abnormal HOMA index observed in 35% of all patients and 67% of those with IGT.
- CGMS revealed higher lowest glucose levels and fewer hypoglycemic episodes in IGT patients.
- Glucose variability tended to be lower in IGT patients and decreased over time post-transplantation.
Conclusions:
- IGT significantly alters lowest glucose levels and hypoglycemic episode incidence in pediatric renal transplant patients.
- Glucose variability decreases with time after transplantation in this cohort.
- Further research is needed to understand the mechanisms and clinical relevance of these findings.
Abstract:
NODAT and IGT are well-known complications of immunosuppressive therapy after transplantation being a risk factor for cardiovascular disease affecting patient and graft survival. Therefore, early identification and treatment are of high importance. In this study, we examined the glycemic homeostasis of 20 renal-transplanted children using routine laboratory tests and the continuous glucose monitoring system (CGMS). Six patients (30%) had IGT, and one patient had NODAT (5%). The HOMA index was in an abnormal range in 35% of all patients and was abnormal in 67% of the IGT patients. CGMS analysis showed that IGT patients had higher "lowest glucose" level, and the incidence of hypoglycemic episodes was significantly lower compared with patients with normal OGTT result. In IGT patients, glucose variability tended to be lower. Furthermore, in the whole patient cohort, glucose variability significantly decreased with time after transplantation. Summarizing, these novel data show that "lowest glucose" level and hypoglycemic episodes are significantly influenced and altered in renal-transplanted patients with IGT. Furthermore, there is a decrease in glucose variability with time after transplantation. The mechanism and relevance of these data need further investigations.
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