Continuous Insulin Therapy to Prevent Post-Transplant Diabetes Mellitus: A Randomized Controlled Trial

Area of Science:

• Nephrology
• Endocrinology
• Transplantation Medicine

Background:

• Hyperglycemia is common post-kidney transplant and linked to post-transplant diabetes mellitus (PTDM).
• Continuous subcutaneous insulin infusion (CSII) was explored to manage early post-transplant hyperglycemia.

Purpose of the Study:

• To assess the efficacy of CSII in managing afternoon hyperglycemia and preventing PTDM in kidney transplant recipients.

Main Methods:

• An open-label, randomized, 3-arm study involving 85 kidney transplant recipients without prior diabetes.
• Participants were assigned to postoperative CSII, basal insulin, or a control group.
• Insulin initiation was based on specific blood glucose thresholds.

Main Results:

• No significant difference in HbA1c at 3 months between CSII and control groups (P=0.70).
• Basal insulin group showed a trend towards lower HbA1c (P=0.02).
• PTDM prevalence at 12 and 24 months was similar across all groups; mild hypoglycemia occurred in insulin groups.

Conclusions:

• CSII therapy did not demonstrate superiority in reducing HbA1c or PTDM prevalence compared to control or basal insulin.
• Limitations include outdated technology and protocol complexity, suggesting further research with advanced methods is needed.