title: Continuous glucose monitoring after kidney transplantation in non-diabetic patients: early hyperglycaemia is frequent and may herald post-transplantation diabetes mellitus and graft failure.
abstract: OBJECTIVE
  New onset of diabetes after transplantation (NODAT) is a known complication of renal transplantation, but early glycaemic status after transplantation has not been described prospectively. This study aimed to assess blood glucose (BG) levels immediately following kidney transplantation in non-diabetic subjects and to explore their relationship to later graft outcomes and NODAT occurrence.
  
  
  METHODS
  Over a 9-month period, 43 consecutive non-diabetic patients who received a kidney transplant were prospectively investigated. During the first 4 days after transplantation, fasting BG was measured and the 24-h BG profile assessed by continuous glucose monitoring (CGM). Capillary BG was measured on hospital admittance and at least four times a day for CGM calibration thereafter. All adverse events were recorded, and fasting BG and HbA1c were assessed at 3, 6 and 12 months and at the last visit to our centre.
  
  
  RESULTS
  Immediately following renal transplantation, capillary BG was 12.2 ± 3.8 mmol/L. On day 1 (D1), fasting BG was 9.9 ± 4.3 mmol/L and decreased to 6.0 ± 1.5 mmol/L on D3. The CGM-reported mean 24-h BG (mmol/L) was 10.2±2.4 on D1, 7.7 ± 1.3 on D2 and 7.5 ± 1.1 on D3. From D1 to D4, 43% of patients spent>12h/day with BG levels>7.7 mmol/L. While morbidity during the 3 months following transplantation appeared unrelated to BG, the first post-transplantation capillary BG measurement and fasting BG on D1 tended to be higher in patients who developed diabetes 3 months later. Tacrolimus treatment was associated with a higher incidence of dysglycaemia at 3 and 6 months. After a mean follow-up of 72 months, NODAT was frequently seen (18.6%), and was associated with tacrolimus medication (P<0.01) and a higher rate of renal transplantation failure (RR: 3.6, P<0.02).
  
  
  CONCLUSIONS
  Hyperglycaemia appears to be a nearly constant characteristic immediately following transplantation in non-diabetic kidney recipients. Higher BG values could identify patients at risk for later post-transplant diabetes and graft failure.
authors.affiliation: Department of Endocrinology, Diabetes, Nutrition, Lapeyronie Hospital, CHU Montpellier, 391, avenue du Doyen-Giraud, 34295 Montpellier cedex 5, France; Institute of Functional Genomics, UMR CNRS 5203, Inserm U661, University of Montpellier, Montpellier, France; Institute of Research in Biotherapies, Montpellier University Hospital, Montpellier, France. Electronic address: a-wojtusciszyn@chu-montpellier.fr.
authors.forename: A
authors.initials: A
authors.lastname: Wojtusciszyn
authors.forename: G
authors.initials: G
authors.lastname: Mourad
authors.forename: J
authors.initials: J
authors.lastname: Bringer
authors.forename: E
authors.initials: E
authors.lastname: Renard
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D015992:Body Mass Index; D003422:Critical Care / Q000379:methods; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006084:Graft Rejection / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents; D016559:Tacrolimus; C517652:hemoglobin A1c protein, human
keywords: Continuous glucose monitoring; Diabète post-transplantation; Hyperglycaemia; Hyperglycémie; Kidney transplantation; Mesure continue du glucose; New onset of diabetes after transplantation; Transplantation rénale