Continuous glucose monitoring in subjects after simultaneous pancreas-kidney and kidney-alone transplantation.
BACKGROUND
Simultaneous pancreas-kidney (SPK) transplantation is an important replacement therapy for individuals with diabetes and end-stage renal disease. Kidney-alone (KA) transplantation is associated with a high incidence of post-transplant diabetes.


METHODS
This was a cross-sectional study. We studied 48-h glucose concentrations in eight subjects with type 1 diabetes mellitus after SPK transplantation, six subjects post-KA transplantation, and nine healthy controls using the CGMS (Medtronic Minimed, Northridge, CA) continuous glucose monitoring system.


RESULTS
The 48-h mean glucose concentration was 101 +/- 7 mg/dL in the SPK subjects, 105 +/- 12 mg/dL in the KA subjects, and 99 +/- 7 mg/dL in the healthy controls. The glycemic excursions were higher in the KA group compared to the SPK cohort and healthy controls (P < 0.0001). No differences in the incidence of hypoglycemia were detected among the three groups. Significant postprandial hyperglycemia was uncovered in four of the six KA subjects.


CONCLUSIONS
SPK transplantation is very effective at normalizing glycemic excursions. Unsuspected hyperglycemia was identified in the KA group. The CGMS was a useful ambulatory tool to study glucose profiles in the post-transplant period and may help uncover hyperglycemia undetected by routine laboratory testing.
Rodríguez
Luisa M
LM
Endocrinology Section, Department of Pediatrics, Baylor College of Medicine , Houston, Texas, USA.
Knight
Richard J
RJ
Heptulla
Rubina A
RA
D000328:Adult; D019540:Area Under Curve; D001786:Blood Glucose / Q000032:analysis* / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000601:surgery; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D016035:Pancreas Transplantation
D001786:Blood Glucose
Transplantation. 2001 Sep 27;72(6):1103-7
11579308
J Am Soc Nephrol. 2006 Dec;17(12 Suppl 3):S291-5
17130277
Surgery. 1993 Oct;114(4):736-43; discussion 743-4
8211688
Ann Surg. 2001 Jun;233(6):740-51
11371732
Diabetes. 1983 Jun;32(6):493-8
6354777
Am J Surg. 1989 Dec;158(6):625-8; discussion 628-9
2589601
Transplantation. 1993 May;55(5):1097-103
8388585
Kidney Int. 2006 Feb;69(3):588-95
16395250
Diabetes Care. 1998 Nov;21(11):1944-50
9802748
Diabetes Care. 2001 Apr;24(4):775-8
11315848
N Engl J Med. 1993 Sep 30;329(14):977-86
8366922
Diabetes. 1983 May;32(5):398-402
6840400
J Pediatr Endocrinol Metab. 1999;12 Suppl 3:751-8
10626266
Eur J Clin Invest. 1994 Nov;24(11):751-8
7890013
Diabetes Care. 2002 Dec;25(12):2256-62
12453970
Diabetes. 1992 Dec;41(12):1632-9
1359986
N Engl J Med. 1987 May 28;316(22):1376-83
3553949
Diabetes. 1994 May;43(5):661-6
8168643
J Clin Invest. 1990 Dec;86(6):2008-13
2254456
Ann Intern Med. 1985 Aug;103(2):184-90
3893253
Diabetes Care. 2002 Mar;25(3):583-92
11874952
Transplantation. 2005 Feb 27;79(4):438-43
15729170
Clin Transpl. 2000;:45-72
11512358
Transpl Int. 2005 Sep;18(9):1054-60
16101726