Hypo- and hyperglycaemia following pancreas transplantation for people with type 1 diabetes

To establish the rates of and variables associated with glycaemic disturbances in people with type 1 diabetes with a functioning pancreas transplant, and to quantify the association with graft failure.

An observational study on routinely collected data from pancreas transplant recipients at University Hospital Wales from January 2013 to April 2019 with glucose tolerance test (GTT) data. Their variables were analysed to assess rates and risk factors for glycaemic disturbance.

Of the 96 participants in this study, 30% developed glycaemic disturbance. Hyperglycaemia was twice as common as hypoglycaemia (22% vs. 10%). Recipients who developed hypoglycaemia were predominantly women (90% vs. 26% for those who developed hyperglycaemia, p = 0.001), had a lower mean BMI (23.7 vs. 27.6 kg/m² for hyperglycaemic individuals, difference: 3.89, CI: 0.77-7.0, p = 0.017). There was no increase in graft failure rates for recipients with glycaemic disturbances (normoglycaemia: 12%, hypoglycaemia: 10%, hyperglycaemia: 4.8%, p = 0.70).

Recipients with post-transplantation hypoglycaemia were more likely to be women and of low body weight, which may be due to disordered eating with restricted calorie or carbohydrate intake. Recipients with post-transplantation hyperglycaemia had features of insulin resistance and type 2 diabetes with increased weight and men predominance. Glycaemic disturbance was not associated with graft failure, suggesting it relates to insulin-glucose mismatch rather than rejection. Further follow-up is required to identify the long-term sequelae of glycaemic disturbance after pancreas transplants and if relevant dietary counselling has the potential to attenuate these disturbances.