title: Continuous glucose monitoring system for early detection of graft dysfunction in allogenic islet transplant recipients.
abstract: BACKGROUND
  There are no effective indicators of graft dysfunction in islet transplantation. This study evaluated the role of the Continuous Glucose Monitoring System (CGMS) as an early indicator of graft dysfunction in islet transplant recipients.
  
  
  METHODS
  In 5 islet allograft recipients, we retrospectively determined the date of graft dysfunction: 3 fasting blood glucose levels >7.8 mmol/L (140 mg/dL) and/or 3 postprandial blood glucose levels >10 mmol/L (180 mg/dL) in 1 week. We then determined 2 time points in respect to graft dysfunction, 5 to 9 months before (time point A) and 2 to 3 months before (time point B). For these 2 time points, we assessed the following: HbA1c, C-peptide (CP), C-peptide glucose ratio (CPGR), 90-minute glucose from mixed meal tolerance test, and percentage of capillary blood glucose levels >7.8 mmol/L (%CBG >7.8) in a 15-day interval (1 week before and after CGMS placement). From the CGMS recordings, we calculated the glucose variability and the percentage of time spent in hyperglycemia >7.8 mmol/L (%HGT >7.8) and >10 mmol/L (%HGT >10).
  
  
  RESULTS
  No difference was found between time points A and B for the following parameters: HbA1c, CP, CPGR, 90-minute glucose, %CBG >7.8, and %HGT >10. We observed a statistically significant increase from time point A to time point B in glucose variability (1.1 +/- 0.5 mmol/L to 1.6 +/- 0.6 mmol/L; P = .004), and in the %HGT >7.8 (11 +/- 12% to 22 +/- 18%; P = .036).
  
  
  CONCLUSIONS
  Glucose variability and %HGT >7.8 determined using CGMS are useful as early indicators of graft dysfunction in islet transplant recipients. Further studies with larger sample sizes will help validate these observations.
authors.affiliation: Diabetes Research Institute, University of Miami-Miller School of Medicine, Miami, Florida 33136, USA.
authors.forename: R N
authors.initials: RN
authors.lastname: Faradji
authors.forename: K
authors.initials: K
authors.lastname: Monroy
authors.forename: A
authors.initials: A
authors.lastname: Riefkohl
authors.forename: L
authors.initials: L
authors.lastname: Lozano
authors.forename: L
authors.initials: L
authors.lastname: Gorn
authors.forename: T
authors.initials: T
authors.lastname: Froud
authors.forename: P
authors.initials: P
authors.lastname: Cure
authors.forename: D
authors.initials: D
authors.lastname: Baidal
authors.forename: G
authors.initials: G
authors.lastname: Ponte
authors.forename: S
authors.initials: S
authors.lastname: Messinger
authors.forename: J
authors.initials: J
authors.lastname: Mastrototaro
authors.forename: C
authors.initials: C
authors.lastname: Ricordi
authors.forename: R
authors.initials: R
authors.lastname: Alejandro
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000473:pathology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood; D012189:Retrospective Studies; D014184:Transplantation, Homologous
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007166:Immunosuppressive Agents