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Early postoperative continuous glucose monitoring in pancreas transplant recipients
Shruti Mittal1, Rachel H Franklin, Caterina Policola
1Oxford Transplant Centre, Oxford University Hospital NHS Trust, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Insights
Continuous glucose monitoring (CGM) effectively tracks glucose levels after pancreas transplantation (PT). While most patients achieve normal glucose, hyperglycemia is common and linked to poorer outcomes, guiding clinical decisions.
Area of Science:
- Endocrinology
- Transplant Surgery
- Metabolic Medicine
Background:
- Continuous glucose monitoring (CGM) is standard for type 1 diabetes management.
- Its utility in pancreas transplantation (PT) recipients is not well-established.
- Early metabolic assessment post-PT is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the metabolic profile of pancreas transplant recipients using CGM in the early post-transplant period.
- To correlate CGM findings with oral glucose tolerance test (OGTT) results.
- To assess the incidence of hypoglycemia and hyperglycemia after PT.
Main Methods:
- Continuous glucose monitoring (CGM) data collected from 30 pancreas transplant (PT) recipients.
- CGM data analyzed for glycemic control (normoglycemia, hypoglycemia, hyperglycemia).
- Correlation of CGM data with early postoperative oral glucose tolerance test (OGTT) results.
Main Results:
- Normoglycemia was achieved 77.9% of the time within 7 days post-PT.
- Hypoglycemic events occurred in 38.5% of recipients but were infrequent (1.4% of time).
- Hyperglycemia occurred 20.7% of the time and correlated with abnormal glucose tolerance and graft failure risk.
Conclusions:
- While normoglycemia is common post-PT, both hypoglycemia and hyperglycemia can occur.
- Hyperglycemia is more prevalent and strongly correlates with early OGTT results, indicating potential graft issues.
- CGM offers a practical, 24-hour method to inform clinical management in the early post-transplant phase.
Abstract:
Continuous glucose monitoring (CGM) is used in people with type 1 diabetes to help with insulin treatment regimens. Its value in whole-organ pancreas transplantation (PT) is largely unknown. This study aimed to use CGM to assess the metabolic profile of pancreas transplant recipients in the early post-transplant period. We studied CGM data in 30 PT recipients and related findings to an early oral glucose tolerance test (OGTT). Complete data were available for 26 recipients. Seven days after a PT, normoglycaemia was present 77.9% of the time. Hypoglycaemic events (glucose <3.9 mmol/l) occurred in 10 of 26 (38.5%) of the cohort, but were infrequent (present 1.4% of the time). Hyperglycaemia (glucose >7.8 mmol/l) was present for 20.7% of the study period and correlated with a diagnosis of abnormal glucose tolerance. Whilst normoglycaemia is successfully achieved for the majority of the time after PT, hypoglycaemia can occur. Hyperglycaemia is more common and correlates well with the early postoperative OGTT, which is associated with graft failure. CGM is easier to perform and provides 24-h data that could inform clinical decision-making in patients in the postoperative period.
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